Stress-shielding in aseptic loosening on the 3D printed acetabular cup in hip arthroplasty: review article

Abstract

The increasing number of prosthetic hip replacement surgeries and their growing indication have led to a growing interest in understanding the factors that influence their long-term success. Total hip arthroplasty (THA) failure is mainly due to aseptic loosening. More rarely septic mobilization may occur. In the first case, many variables influence the bone-implant relationship and periprosthetic bone remodeling. Stress-shielding is the most evident but not fully explained manifestation of the bone implant interaction. Recently, three-dimensional (3D) printed titanium orthopedic implants have offered new perspectives in the field of hip prosthetics, enabling the customization and production of acetabular cups with enhanced biocompatibility. This review aims to evaluate the efficacy and reliability of 3D printed acetabular cups from the perspective of aseptic failure particularly related to the stress-shielding. The most recent clinical and preclinical studies will be reviewed, exploring the benefits and challenges associated with the use of these emerging technologies. Key factors, such as biocompatibility, mechanical stability, osseointegration, and wear resistance.

Keywords

3D printed / acetabular cup / hip arthroplasty / stress-shielding / aseptic loosening

References

[1] Neuprez A, Neuprez AH, Kaux JF, Kurth W, Daniel C, Thirion T, et al. Total joint replacement improves pain, functional quality of life, and health utilities in patients with late-stage knee and hip osteoarthritis for up to 5 years. Clin Rheumatol. 2020; 39: 861-71.

[2] Logroscino G, Magliocchetti Lombi G, Aulisa GA, Proietti L, Fabbriciani C. Aseptic and septic mobilization in hip arthoplasty. Clin Ter. 2005; 156: 51-65. Italian.

[3] Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA. Highly-porous metal option for primary cementless acetabular fixation. What is the evidence? Hip Int. 2013; 23: 509-21.

[4] Banerjee S, Kulesha G, Kester M, Mont MA. Emerging technologies in arthroplasty: additive manufacturing. J Knee Surg. 2014; 27: 185-91.

[5] Meng M, Wang J, Huang H, Liu X, Zhang J, Li Z. 3D printing metal implants in orthopedic surgery: Methods, applications and future prospects. J Orthop Translat. 2023; 42: 94-112.

[6] Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89: 780-5.

[7] Huiskes R. Failed innovation in total hip replacement: Diagnosis and proposals for a cure. Acta Orthop Scand. 1993; 64: 699-716.

[8] Tozzi G, Zhang QH, Tong J. Microdamage assessment of bone-cement interfaces under monotonic and cyclic compression. J Biomech. 2014; 47: 3466-74.

[9] Dobrzański LA, Dobrzańska-Danikiewicz AD, Dobrzański LB. Effect of Biomedical Materials in the Implementation of a Long and Healthy Life Policy. Processes. 2021; 9: 865.

[10] Bitar D, Parvizi J. Biological response to prosthetic debris. World J Orthop. 2015; 6: 172-89.

[11] Frost HM. Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod. 1994; 64: 175-88.

[12] Oftadeh R, Perez-Viloria M, Villa-Camacho JC, Vaziri A, Nazarian A. Biomechanics and mechanobiology of trabecular bone: a review. J Biomech Eng. 2015; 137: 010802.

[13] Savio D, Bagno A. When the Total Hip Replacement Fails: A Review on the Stress-Shielding Effect. Processes. 2022; 10: 612.

[14] Wright JM, Pellicci PM, Salvati EA, Ghelman B, Roberts MM, Koh JL. Bone density adjacent to press-fit acetabular components. A prospective analysis with quantitative computed tomography. J Bone Joint Surg Am. 2001; 83: 529-36.

[15] Wilkinson JM, Peel NF, Elson RA, Stockley I, Eastell R. Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty. J Bone Joint Surg Br. 2001; 83: 283-8.

[16] Kostewicz M, Szczęsny G, Tomaszewski W, Małdyk P. Narrative Review of the Mechanism of Hip Prosthesis Dislocation and Methods to Reduce the Risk of Dislocation. Med Sci Monit. 2022; 28: e935665.

[17] Merola M, Affatato S. Materials for Hip Prostheses: A Review of Wear and Loading Considerations. Materials (Basel). 2019; 12: 495.

[18] Kim JT, Yoo JJ. Implant Design in Cementless Hip Arthroplasty. Hip Pelvis. 2016; 28: 65-75.

[19] Dipaola M, Wodajo F, editors. 3D Printing in Orthopaedic Surgery. Elsevier; 2018.

[20] Duda T, Raghavan LV. 3D Metal Printing Technology. IFAC Pap OnLine. 2016; 49: 103-10.

[21] DebRoy T, Wei HL, Zuback JS, Mukherjee T, Elmer JW, Milewski JO, et al. Additive manufacturing of metallic components - Process, structure and properties. Prog Mater Sci. 2018; 92: 112-224.

[22] King WE, Barth HD, Castillo VM, Gallegos GF, Gibbs JW, Hahn DE, et al. Observation of keyhole-mode laser melting in laser powder-bed fusion additive manufacturing. J Mater Process Technol. 2014; 214: 2915-25.

[23] Mukherjee T, Zuback JS, De A, DebRoy T. Printability of alloys for additive manufacturing. Sci Rep. 2016; 6: 19717.

[24] Sames WJ, List FA, Pannala S, Dehoff RR, Babu SS. The metallurgy and processing science of metal additive manufacturing. Int Mater Rev. 2016; 61: 315-60.

[25] Perticarini L, Zanon G, Rossi SMP, Benazzo FM. Clinical and radiographic outcomes of a trabecular titanium™ acetabular component in hip arthroplasty: results at minimum 5 years follow-up. BMC Musculoskelet Disord. 2015; 16: 375.

[26] Castagnini F, Bordini B, Stea S, Calderoni PP, Masetti C, Busanelli L. Highly porous titanium cup in cementless total hip arthroplasty: registry results at eight years. Int Orthop. 2019; 43: 1815-21.

[27] Geng X, Li Y, Li F, Wang X, Zhang K, Liu Z, et al. A new 3D printing porous trabecular titanium metal acetabular cup for primary total hip arthroplasty: a minimum 2-year follow-up of 92 consecutive patients. J Orthop Surg Res. 2020; 15: 383.

[28] Dall’Ava L, Hothi H, Di Laura A, Henckel J, Hart A. 3D Printed Acetabular Cups for Total Hip Arthroplasty: A Review Article. Metals. 2019; 9: 729.