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THR Femoral Component
THR Femoral Component
Acetabular component
1.Cup
Neck length and off-set determine the neck-shaft angle and abductor muscle
lever arm
•The ideal femoral reconstruction reproduces the normal center of rotation of
femoral head, which can be determined by :
Cementless/
Cemented
Biological
1. Collarless
2. Highly polished fixation surface
3. Tapered profile from proximal to distal.
• These features prevent the stem from bonding with
cement.
• The stem therefore settles in cement, re-engaging its taper,
and so the fixation becomes progressively more stable;
therefore it is considered a ‘slip and slide’ prosthesis
• To prevent stress on cement distally during subsidence air
filled centralizer is used as a cushion.
• Eg Exeter stem, CPT stem of Zimmer double tapered or
three planes(C-stem of Depuy)
Generation cementing techniques
First-generation:
•Involved hand mixing of cement and finger packing of bone cement in the doughy phase into an
unplugged, unwashed femoral canal.
•Clinical results with first-generation cementing have been variable and in general have produced
some disappointing results due to its inability to produce a consistent cement mantle.
Second-generation:
•Involved plugging the medullary canal, cleaning the canal with pulsed lavage and inserting cement
in a retrograde manner using a cement gun.
•This reduced the incidence of gross voids and filling defects in the mantle.
Third-generation :
•Involves porosity reduction via vacuum mixing
or centrifugation and cement pressurization.
Fourth-generation:
•Include stem centralization both proximally and
distally to ensure an adequate and symmetrical
cement mantle.
• This is important as uneven and excessively
thin cement mantles are associated with early
failure and revision
Cement fixation optimized by
• Limited porosity of cement: leads to reduced stress points in cement
• Cement mantle: > 2mm
Increased risk of mantle fractures if < 2mm
• Femoral stem : Stiff
Flexible stem places stress on cement mantle
• Position of Stem: central
Avoid mal-position of stem to decrease stress on cement mantle
• Femoral stem: Smooth
Sharp edges produce sites of stress concentration
• Absence of mantle defects: (mantle defect-any area where the prosthesis touches cortical bone with no cement
between)
Creates an area of higher concentrated stress and is associated with higher loosening rates
• Proper component positioning within femoral canal: varus stem positioning increases stress on cement mantle
Cementless fixation
III. Minimal gap distance between prosthesis and bone: less than 50 μm.
V. Cortical contact with bone : Shear and torsional strength is stronger when
implant is adjacent to cortical bone as opposed to cancellous bone
VI.Viable bone ; Prior irradiation to pelvis and hip increases risk for aseptic
loosening of bone ingrowth/ongrowth implants.
Bone on-growth design
• On growth refers to bone growth over a roughened
surface.
On growth surfaces are created by:
Surface roughness (Ra)
1. Grit blasting :
• Involves high pressure bombarding implant with
small abrasive particles such as corundum to
create microdivots on the surface, which are of
similar size to pores in porous coated designs.
• The depth of the divot (distance from peak to
valley) is referred to as the surface roughness
(between 3-5 micrometer)of the stem.
• Bone grows into the divots achieving biological
fixation.
2. Plasma spraying :
•Involves high temperature metal spray on
surface of implant to create a textured surface
with mixing metal powder with an inert gas
that is pressurized and ionized, forming a high-
energy flame.
•The molten material is sprayed onto the
implant to create a textured surface.
Proximal coating vs extensively coating cementless stem in terms of loading
1. Press fit or
2. Frictional fit/ line-to-line fixation
1. Press fit :
• Press fit fixation is achieved by
under-reaming of the bone.
• Slightly larger implant than what
was reamed is wedged into position
• When the prosthesis is wedged in,
compression hoop stresses stabilise
the implant to achieve a rigid
fixation.
2. Frictional fit:
•Achieved by line-to-line reaming of the bone.
•Bone is prepared such that contour of bone is
same size as implant.
•The rough surface of the prosthesis provides
enough resistance to motion, which achieves
implant stability when it is impacted into its
final position.
•This is also called scratch fit or interference
fit.
Advantages of cementless femoral stem prosthesis