Acetabular Cup Stiffness and Implant Orientation Change Acetabular Loading Patterns

Acetabular cup orientation has been shown to influence dislocation, impingement, edge loading, contact stress, and polyethylene wear in total hip arthroplasty. Acetabular implant stiffness has been suggested as a factor in pelvic stress shielding and osseous integration. This study was designed to examine the combined effects of acetabular cup orientation and stiffness and on pelvic osseous loading. Four implant designs of varying stiffness were implanted into a composite hemipelvis in 35° or 50° of abduction. Specimens were dynamically loaded to simulate gait and pelvic strains were quantified with a grid of rosette strain gages and digital image correlation techniques. Changes in the joint reaction force orientation significantly altered mean acetabular bone strain values up to 67%. Increased cup abduction resulted in a 12% increase along the medial acetabular wall and an 18% decrease in strain in inferior lateral regions. Imbalanced loading distributions were observed with the stiffer components, resulting in higher, more variable, and localized surface strains. This study illustrates the effects of cup stiffness, gait, and implant orientation on loading distributions across the implanted pelvis.