referring to the drawings wherein like reference characters designate like parts throughout the several views , an integral acetabular cup assembly 2 is shown . as may best be seen in fig2 assembly 2 includes an inner liner 4 , a series of spacers 6 and a metal backing 8 . referring to particular to fig6 and fig7 liner 4 is shown separately in sectional view and bottom view respectively . liner 4 includes an inner surface 10 and an outer surface 12 . inner surface 10 and outer surface 12 are generally hemispherical in shape . inner surface 10 terminates at beveled annular surface 14 . outer surface 12 terminates at annular lip 23 . lip 23 , in turn , is connected to notch 16 which is comprised of side walls 17 , 19 and 21 . the surface area between beveled surface 14 and notch 16 comprises an annular , peripheral rim 18 . rim 18 includes a beveled surface 20 connected to sidewall 17 and a top surface 22 connected to beveled surface 14 . surfaces 20 and 22 are connected at radius 24 . in use , inner surface 10 of liner 4 provides the bearing surface for a femoral head used in effecting a total hip replacement . the femoral head and related neck prosthesis used in effecting total hip joint replacement has not been shown as well known in the art . the femoral head which is ultimately chosen for use with liner 4 and the manner in which the femoral head and liner 4 are sized are also well known in the art and form no part of the present invention . inner liner 4 may be molded or machined from a synthetic plastics material such as a high density polyethylene . an ultra - high molecular weight polyethylene provides proven bearing surface and is generally preferable for receiving the head of the femoral prosthesis . metal backing 8 , on the other hand , may be made of a titanium alloy or other bicompatible metal . the preferred embodiment is machined from titanium - 6 alluminum - 4 vanadium , eli grade , bar stock . such metallic material is commonly used in implants because of its good bio - compatibility , and its relative low modulus of elasticity . the cross - sectional thicknesses of metal backing 8 is generally a uniform 2 millimeters . this is reduced in the area of the grooves as will be explained hereinafter . metal backing 8 may be best described in connection with fig4 and fig5 . it generally comprises an inner surface 26 and an outer surface 28 with four apertures therebetween labeled 30 and 32 . metal backing 8 is generally hemispherical in shape with aperture 32 at its apex . apertures 30 are preferably radially disposed from and equidistant from aperture 32 . apertures 30 and 32 may preferentially be substantially similiar in size and shape . as perhaps best shown in connection with fig4 apertures 30 and 32 are generally cylindrical and counterbored . they include larger cylindrical walls 34 , small cylindrical walls 36 and interconnecting wall 38 . inner surface 26 of metal backing 8 extends radially outward from central aperture 32 to beveled seat 40 . seat 40 is annularly disposed on inner surface 26 and is connected between inner surface 26 and notch 42 . the other side of notch 42 is connected to annular lip 44 . notch 42 , as well as lip 44 , is angularly disposed around the circumference of inner surface 26 . inner surface 26 and outer surface 28 are connected by top surface 46 . outer surface 28 includes equatorial grooves 48 and polar grooves 50 . equatorial grooves 48 may be best seen in reference to fig2 and fig4 . polar grooves 50 , on the other hand , are best seen in fig2 and fig5 . the purposes and advantages in grooves 48 and 50 will be described hereinafter . referring to fig2 and 8 , the spacers 6 will be described in detail . spacers 6 are comprised of a generally cylindrically - shaped head portion 52 and a generally hemispherically - shaped body 54 . depending upon the spacer used , they may in addition preferentially include a second cylindrical shank portion 56 to provide additional overall height to the spacers 6 . cylindrical portion 52 is connected to cylindrical portion 56 or hemispherical portion 54 by surface 58 . the tops of spacers 6 are comprised of a substantially circular and planar surface 60 . spacers 6 are preferably made of polymethylmethacrylate as noted earlier . spacers 6 with an overall height of 3 mm beyond outer surface 28 have been found to be preferred . this is generally considered to be the optimum cement thickness . any number of spacers 6 may be used in any distribution that will fit a hemisphere . polymethylmethacrylate bone cement is known to be compatible with all modern prostheses and techniques . the surface of the polymerized acrylic spacers 6 is said to chemically bond when the new cement dough is introduced . this bond is said to eliminate any type of stress riser that may otherwise arise due to the insertion of the spacer within the acetabulum . hemispherical portion 54 of spacers 6 allows greater flexibility of positioning of acetabular cup assembly 2 within the acetabulum . prior to insertion into the acetabulum , inner liner 4 , spacer 6 and metal backing 8 must be assembled . first , metal backing 8 is machined from titanium - 6 aluminum - 4 vanadium , eli grade bar stock as noted earlier . next , inner liner 4 is machined from ultra - high molecular weight polyethylene . spacers 6 are preferably injection molded from polymethylmethacrylate . at room temperature , spacers 6 are dropped into apertures 30 and 32 . the outer surfaces of spacers 6 are dimensionally suited and adapted to substantially contact their mating surfaces of apertures 30 and 32 . more particularly , walls 34 are juxtapositioned against cyclindrical portions 52 , walls 38 contact surfaces 58 , and walls 36 are juxtapositioned with surfaces 56 . next , inner liner 4 is chilled in liquid nitrogen . being careful not to mar any of the surfaces of inner liner 4 , inner liner 4 is placed within metal backing 8 . as inner liner 4 warms to room temperature , it expands to a close fit within the metal backing 8 . surfaces 12 and 26 are preferably contacted throughout their interface . this mechanically entraps spacers 6 within their respective apertures 30 and 32 , and eliminates the potential for liner 4 to cold flow into any gap that might otherwise exist between surfaces 12 and 26 . once the assembly is completed and warmed to room temperature , inner liner 4 is mechanically locked within metal backing 8 by the interaction of annular notch 16 , annular ridge 23 and annular lip 44 . lip 44 fits snugly within notch 16 . lip 23 is juxtaposed to seat 40 and fits snugly within annular notch 42 to prevent the disassociation of inner liner 4 and backing 8 . it has been found that the tolerances on inner liner 4 and metal backing 8 can be closely controlled to achieve the intimate contact required to effectively limit cold flow deformation of the preferred polyethylene liner 4 . the placement of integral acetabular assembly 2 within the acetabulum is shown in fig3 . the surgical procedure for inserting assembly 2 within the acetabulum is to prepare the acetabulum by reaming the generally spherical bone surface 61 to a spherical diameter size which is generally equal to the diameter of radius 24 of rim 18 . in this manner , the acetabulum will be prepared with an increased size in order to accomodate the additional height or thickness of spacers 6 and yet still position the acetabular cup assembly 2 in the correct position . during this reaming procedure , instruments may be placed in position to check for evenness of reaming and correct alignment . it is important that the acetabulum be cleaned and dried prior to introduction of the acrylic bone cement 62 into the interface . care should also be taken not to handle the spacers 6 in order to prevent coating spacers 6 with contaminate materials which could impede the polymerization process . after the acrylic bone cement has been inserted and pressurized on surface 61 , acetabular cup assembly 2 is manually pushed into position until it is felt to rest against bone surface 61 . at this time , it is possible to firmly hold the acetabular cup in place and simultaneously allow the surgeon to use both hands to smooth and effectively pack the cement around the acetabular cup . once this packing is completed , the area is trimmed and a smooth surface formed . when seating assembly 2 within the acetabulum , beveled surface 20 of rim 18 serves to further pressurize the acrylic bone cement 62 . the hemispherical portion 54 of spacers 6 further tends to eliminate occlusions in the cement 62 and aid in the placement of assembly 2 upon surface 61 by not being sensitive to positioning . by this it is meant that , regardless of orientation or biasing within the acetabulum , each of spacers 6 will have a substantially identical point contact with surface 61 . this insures a uniform thickness to bone cement 62 and further minimizes the possibility of unintentionally forming stress risers within the bone cement . equatorial grooves 48 and polar grooves 50 tend to enhance fixation of the prosthesis to the cement layer . grooves 48 and 50 are generally hemispherical in cross section and preferably radiused at the periphery to avoid stress risers and to insure even and complete filling of grooves 48 and 50 with bone cement 62 when assembly 2 is pressed into the acetabulum . grooves 48 and 50 are preferably , approximately 1 . 5 mm deep . equatorial grooves 48 interlock with bone cement 62 to provide additional stability to assembly 2 during the tension / compresion loading encountered in use . polar grooves 50 also interlock with cement 62 to provide additional stability to assembly 2 . the stability added by grooves 50 is primarily against the torsional forces encountered during use . from the foregoing , it will be apparent that all of the objectives of this invention have been achieved by the acetabular cup assembly shown and described . it will also be apparent that various modifications and changes may be made by those skilled in the art without departing from the spirit of the invention as expressed in the accompanying claims . therefore , all matter shown and described is to be interpreted as illustrative and not in a limiting sense .
an integral prosthetic acetabular cup assembly and a method for making the same including an inner liner contacting an outer backing and a plurality of spacers mechanically entrapped between the inner liner and the outer backing . the spacers may be made of a material different from that of the inner liner and of the outer backing .