Total Hip Replacement: Tensile Stress in Bone Cement is influenced by Cement Mantle Thickness, Acetabular Size, Bone Quality, and Body Mass Index

Background: High stress developed in the cement mantle of a total hip replacement is reported to contribute to premature failure of acetabular components. We postulate that stress level is influenced by cement mantle thickness, acetabular size, bone quality and body mass index. Methods: Finite element models of reconstructed hemi pelves of different sizes and acetabular diameters (46, 52 and 58 mm) were created from CT-Scan data. We investigated the effects of cement mantle thickness (1, 2, 3 and 4 mm), acetabular size, body mass index (BMI = 20, 25 and 30 kg/m2) and bone quality on stress level developed in the cement mantle. Findings: Peak tensile stresses in the cement mantle increased with a decrease in cement mantle thickness, acetabular size and bone quality and an increase in BMI. Interpretation: Our results indicate that a 4-mm-thick cement mantle is required in small reconstructed acetabulae of ≤ 50-mm diameters, while a 1-mm thick cement mantle can be used on larger reconstructed acetabulae of ≥ 58 mm diameter. Patients with poor bone quality require at least a 4-mm-thick cement mantle to reduce the risk failure caused by high stress level in the cement mantle.