Cement-Bone Interface in Revision Arthroplasty

Karachalios, Theofilos; Makridis, Konstantinos G.

doi:10.1007/978-1-4471-5409-9_12

Cited by 4 publications

(6 citation statements)

References 78 publications

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“…Cement interdigitates with cancellous bone, and it is this interlock that provides its fixation strength to bone (1). Femoral bone in revision surgery is often smooth and sclerotic, and biomechanical tests have found a cemented revision stem to have 80% less shear strength than a primary cemented stem (9).…”

Section: Historical Implant Options In Revision Thamentioning

confidence: 99%

“…A visibly intact cement mantle without residual cracks is a prerequisite to perform this procedure. Once the previous cement mantle has been cleaned, the new cement is inserted in a low-viscosity state (1). Some authors advocate marking the previous cement mantle for improved interdigitation (19, 20).…”

Section: Contemporary Treatment Optionsmentioning

confidence: 99%

“…The risk of aseptic loosening and failure increases when femoral bone deficiency exceeds the mechanical and biologic tolerances of the implanted device. Two examples in revision total hip arthroplasty (THA) include cemented stems and proximally-coated cementless implants, both of which had high early failure rates due to the inability of revision host bone to provide an adequate cancellous-cement interlock or viable bone capable of biologic ingrowth (1). Alternative treatment strategies have focused on achieving fixation distal to damaged proximal bone, with the development of cylindrical extensively porous-coated implants and titanium modular fluted tapered stems and both have demonstrated excellent long-term results (2–4).…”

Section: Introductionmentioning

confidence: 99%

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Management of Femoral Bone Loss in Revision Total Hip Arthroplasty

2015

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Femoral bone loss is frequently encountered during revision total hip arthroplasty. The quality and quantity of remaining bone helps determine the best method for reconstruction. Extensively porous-coated cylindrical stems or titanium fluted tapered devices that achieve fixation in the diaphysis have both demonstrated excellent long-term survivorship. Titanium fluted tapered stems with a modular proximal body allow for more accurate leg length, offset, and version adjustments independent of the distal stem which may optimise hip biomechanics. Intraoperative fractures are more common with cylindrical stems and subsidence with tapered stems, particularly monoblock designs and in both dislocation continues to be one of the most common postoperative complications. In salvage situations in which an ectatic femoral canal is unable to support an uncemented device, impaction bone grafting, allograft-prosthetic composite, or a segmental proximal femoral replacement may be required.

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Section: Historical Implant Options In Revision Thamentioning

confidence: 99%

Section: Contemporary Treatment Optionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of Femoral Bone Loss in Revision Total Hip Arthroplasty

2015

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“…Osseointegration phenomena [4] are stimulated by the application of mechanical stimuli to the bone–implant interface (BII). Moreover, the implant surface roughness, which is obtained using different processes such as, for example, sand blasting [5], plasma spraying [6], or laser blasting [7], is known to strongly influence the quality of osseointegration phenomena [8]. When the primary stability is not sufficient, micro-movements may appear, preventing good healing conditions and leading to the formation of fibrous tissue and eventually to surgical failure [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Micromechanical modeling of the contact stiffness of an osseointegrated bone–implant interface

2019

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BackgroundThe surgical success of cementless implants is determined by the evolution of the biomechanical properties of the bone–implant interface (BII). One difficulty to model the biomechanical behavior of the BII comes from the implant surface roughness and from the partial contact between bone tissue and the implant. The determination of the constitutive law of the BII would be of interest in the context of implant finite element (FE) modeling to take into account the imperfect characteristics of the BII. The aim of the present study is to determine an effective contact stiffness of an osseointegrated BII accounting for its micromechanical features such as surface roughness, bone–implant contact ratio (BIC) and periprosthetic bone properties. To do so, a 2D FE model of the BII under normal contact conditions was developed and was used to determine the behavior of .ResultsThe model is validated by comparison with three analytical schemes based on micromechanical homogenization including two Lekesiz’s models (considering interacting and non-interacting micro-cracks) and a Kachanov’s model. is found to be comprised between 1013 and 1015 N/m3 according to the properties of the BII. is shown to increase nonlinearly as a function of the BIC and to decrease as a function of the roughness amplitude for high BIC values (above around 20%). Moreover, decreases as a function of the roughness wavelength and increases linearly as a function of the Young’s modulus of periprosthetic bone tissue.ConclusionsThese results open new paths in implant biomechanical modeling since this model may be used in future macroscopic finite element models modeling the bone–implant system to replace perfectly rigid BII conditions.

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“…These implants have different microstructure surfaces such as sintered beads, fiber mesh, porous metal, and with or without the addition of hydroxyapatite on the surface. 4,5 The study of osseointegration of bone fiber with titanium, 4–6 tantalum 7,8 and ceramic 9 coated prosthesis has been reported in the literature. However, there is a lack of comparative data on osseointegration and stability of the bone implant connection of newly-developed surfaces of the acetabular component in normal bone mineral density and in osteopenia and osteoporosis patients.…”

Section: Introductionmentioning

confidence: 99%