Patient and surgical variability in the primary stability of cementless acetabular cups: A finite element study

Aseptic loosening is the most common indication for revision of cementless acetabular cups and often depends on the primary stability achieved following surgery. Cup designs must be capable of achieving primary stability for a wide variety of individuals and surgical conditions to be successful. Typically, preclinical finite element (FE) testing of cups involves assessing the performance in a single patient and under a limited set of idealized conditions. The aim of this study was to assess the effect of patient and surgical parameters on the primary stability of an acetabular cup design in a set of subject-specific FE models. Interference fit was varied in a representative set of 12 patient-specific models of the implanted hemipelvis. Linear mixed models showed a significant association with micromotion for interference fit (P < .0001), acetabular bone elastic modulus (P < .001), native acetabular diameter (P  = .03), and the interference fit-elastic modulus interaction (P = .01). There were no significant associations between the polar gap and any of the parameters considered. The significant interference fit-elastic modulus interaction suggests that increasing the interference fit in patients with low bone quality leads to a greater reduction in micromotion than in patients with higher bone quality. However, the significant association between percentage bone yielding and interference fit (P < .0001) suggests a higher periacetabular fracture risk at higher interference fits. This work supports the development of preclinical testing of cup designs for the broad range patients and surgical conditions a cup may face following surgery.