The Cemented All-Polyethylene Acetabular Component

CHAPTER 16 The Cemented All-Polyethylene Acetabular Component



Amar S. Ranawat, Chitranjan S. Ranawat



CHAPTER OUTLINE



Indications and Contraindications 137

Preoperative Planning 138

Technique 138

Perioperative and Postoperative Management 140

Complications 140

Summary 141



KEY POINTS



image This component is the most common fixation choice worldwide: “the gold standard.”

image Its use is indicated for most osteoarthritic acetabula and especially irradiated bone.

image Its use is contraindicated in poor bone, with acetabular deformities, and with excessive bleeding.

image Long-term results are technique dependent.

image It may become more popular owing to the early success of the reverse hybrid total hip arthroplasty.

The use of cemented all-polyethylene acetabular components has been dramatically reduced in the United States in the past decade as a result of the increasing trend toward noncemented fixation. Nonetheless, it remains the most common form of acetabular fixation worldwide. The reasons for this are numerous. A well-done cemented acetabular component is durable, reproducible, and inexpensive and has a predictable failure mechanism (Fig. 16-1).


image

FIGURE 16-1 An all-polyethylene acetabular component with highly cross-linked polyethylene (Crossfire, Stryker Orthopaedics, Allendale, NJ). Note polymethylmethacrylate spacers to allow for adequate cement mantle.


(Reprinted with permission from Callaghan JJ, Rosenberg AG, Rubash HE [eds]: The Adult Hip. Philadelphia, Lippincott Williams and Wilkins, 2007.)


Moreover, recent evidence from the Swedish Registry has shown excellent results in younger, active patients with the use of the so-called reverse hybrid total hip arthroplasty (a cemented all-polyethylene acetabulum with a noncemented femur) that has fueled renewed interest in the cemented socket.


In any event, the technique of cementing in an acetabular component should be part of the armamentarium of all U.S. hip arthroplasty surgeons if for no other reason than to better cement a new liner into a well-fixed metal shell during revision surgery.



INDICATIONS AND CONTRAINDICATIONS


For many surgeons, the cemented all-polyethylene acetabulum is indicated for all comers regardless of age, diagnosis, or deformity (Table 16-1). In our experience, the survivorship of a cemented all-polyethylene acetabular component at 10 to 20 years was 98% in patients with a life expectancy of less than 30 years with osteoarthritis and good bone stock. We also prefer to use cemented fixation in the irradiated pelvis owing to the diminished potential for biologic ingrowth.



TABLE 16-1 FAILURE OF CEMENTED ACETABULUM: REVIEW OF THE LITERATURE

image

There are, however, certain circumstances in which press-fit fixation has a distinct advantage. These include acetabular deformities such as dysplasia and protrusio acetabuli, inflammatory arthropathies with significant osteopenia, and cases in which excessive acetabular bleeding cannot be controlled with hypotensive anesthesia.


Finally, as a general rule we will avoid cemented fixation in patients with significant cardiopulmonary disease because of the concern for embolic phenomenon during pressurization.



PREOPERATIVE PLANNING


We use a standing low anteroposterior pelvis with the proximal third of the femora to do most of our templating as well as a false profile view of the affected hip. Standing anteroposterior and lateral lumbosacral views are also obtained to aid in the evaluation of the accentuation or loss of normal lumbar lordosis. If there is loss of lumbar lordosis and the deformity is fixed, we will reduce the anteversion of our socket placement to avoid anterior dislocation. Conversely, we will increase the anteversion if there is hyperlordosis to protect against posterior dislocation.


Our goal is to reproduce the anatomic geometry of the hip in terms of leg length, offset, and accurate component positioning. Cemented fixation, in general, affords a greater flexibility in restoring the geometry of the hip because the surgeon has the ability to secure the components wherever he or she desires. With proper templating, the risk of developing a significant leg length discrepancy or component malposition is quite low.



TECHNIQUE

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The Cementless Tapered Stem Femoroacetabular Osteoplasty Reconstruction of Acetabular Bone Deficiencies Using the Antiprotrusio Cage The Cemented Stem Management of Postoperative Hematomas The Cemented Stem

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Mar 10, 2016 | Posted by in Reconstructive surgery | Comments Off on The Cemented All-Polyethylene Acetabular Component

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