Influence of acetabular cup thickness on seating and primary stability in total hip arthroplasty

Insufficient primary stability of acetabular hip cups is a complication resulting in early cup loosening. Available cup designs vary in terms of wall thickness, potentially affecting implant fixation. This study investigated the influence of different wall thicknesses on the implantation process and the resulting primary stability using excised human acetabula. Implantations were performed using a powered impaction device providing consistent energy with each stroke. Two different wall thicknesses were compared in terms of seating progress, polar gap remaining after implantation, bone-to-implant contact area, cup deflection, and lever out moment. Thin-walled cups showed higher lever out resistance (p < 0.001) and smaller polar gaps (p < 0.001) with larger bone contact toward the dome of the cup (p < 0.001) compared to thick-walled cups. Small seating steps at the end of the impaction process were observed if a high number of strokes were needed to seat the cup (p = 0.045). A high number of strokes led to a strain release of the cup during the final strokes (p = 0.003). This strain release is indicative for over-impaction of the cup associated with bone damage and reduced primary stability. Adequate cup seating can be achieved with thin-walled cups with lower energy input in comparison to thicker ones. Thin-walled cups showed improved primary stability and enable implantation with lower energy input, reducing the risk of over-impaction and bone damage. Additional strokes should be avoided as soon as no further seating progress has been observed.