Impaction procedure influences primary stability of acetabular press-fit components

Abstract

The aim of the study was to investigate whether the primary stability of press-fit acetabular components can be improved by altering the impaction procedure. Three impaction procedures were used to implant acetabular components into human cadaveric acetabula using a powered impaction device. An impaction frequency of 1 Hz until complete component seating served as reference. Overimpaction was simulated by adding ten strokes after complete component seating. High-frequency implantation was performed at 6 Hz. The lever-out moment of the acetabular components was used as measure for primary stability. Permanent bone deformation was assessed by comparison of double micro-CT (µCT) measurements before and after impaction. Acetabular component deformation and impaction forces were recorded, and the extent of bone-implant contact was determined from 3D laser scans. Overimpaction reduced primary acetabular component stability (p = 0.038) but did not significantly increase strain release after implantation (p = 0.117) or plastic deformations (p = 0.193). Higher press-fits were associated with larger polar gaps for the 1 Hz reference impaction (p = 0.002, R2 = 0.77), with a similar trend for overimpaction (p = 0.082, R2 = 0.31). High-frequency impaction did not significantly increase primary stability (p = 0.170) at lower impaction forces (p = 0.001); it was associated with smaller plastic deformations (p = 0.035, R2 = 0.34) and a trend for increased acetabular component relaxation between strokes (p = 0.112). Higher press-fit was not related to larger polar gaps for the 6 Hz impaction (p = 0.346). Overimpaction of press-fit acetabular components should be prevented since additional strokes can be associated with increased bone damage and reduced primary stability as shown in this study. High-frequency impaction at 6 Hz was shown to be beneficial compared with 1 Hz impaction. This benefit has to be confirmed in clinical studies.