Cement-Implant Interface Contamination: Possible Reason of Inferior Clinical Outcomes for Rough Surface Cemented Stems

Abstract

Background:Shape-closed cemented implants rely on a stronger bond and have displayed inferior clinical outcomes when compared to force-closed designs. Implant contamination such as saline, bone marrow and blood prior to cement application has the potential to affect the cement-implant bond. The consequences of implant contamination were investigated in this study.Methods:Fifty Titanium alloy (Ti-6Al-4V) dowels were separated into ten groups based on surface roughness and contaminant, and then cemented in polyvinyl chloride tubes. Push-out testing was performed at 1mm per minute. The roughness of the dowel surface was measured before and after the testing. The dowel surface and cement mantel were analyzed using a Scanning Electron Microscopy (SEM) to determine the distribution and characteristics of any debris and contaminants on the surface.Results:Contaminants largely decreased stem-cement interfacial shear strength, especially for rough surfaces. Saline produced the greatest decrease, followed by blood. The effect of bone marrow was less pronounced and similar to that of oil. Increasing surface roughness increased the interfacial bonding strength, even with contaminants. There was a non-significant increase in mean bonding strength for smooth surfaces with bone marrow and oil contamination. SEM showed that contaminants influence the interfacial bond by different mechanisms. More debris was found on rough samples following testing.Conclusions:The results of this study underscore the importance of keeping an implant free from contamination, and suggest if contamination does occur, a saline rinse may further decrease the stability of an implant. The deleterious effects of contamination on rough surface cement bonding were considerable, and indicate that contamination at the time of surgery may, in part, contribute to inferior clinical outcomes for rough surfaced cemented stems.

Compression and Flexural Strength of Bone Cement Mixed with Blood

“…11,24,26,27 When PMMA cement is contaminated with blood, micro-morphological changes to gap and void formation in the surface structure may develop, and shear strength is markedly reduced. 22 In our study, after flexural and compressive strength testing, fractures within the cement mantle consistently occurred in areas of weakness caused by blood laminations, which were not noted before curing and were more prominent after curing to the extent of disrupting the previously smooth cylindrical contour of the specimen (Fig. 2).…”

Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection

“…The ingrowth of cementless components in the postoperative period is important for long-term stability of the implant [29]. Vigorous manipulation of cemented implants might damage the cement-implant interface, with unfavorable consequences for implant survival [30]. In late PJI (i.e.…”

Effect of Physiological Fluids Contamination on Selected Mechanical Properties of Acrylate Bone Cement

“…The results from their study are particularly interesting given that bone-cement compositions with antibiotics introduced by the manufacturer are widely used in Europe, whereas in the United States manual antibiotic powder addition to traditional bone cement during surgery is preferred [44]. The authors of other studies [34,45] monitored the formation of gaps and voids in the micromorphological structure of the blood-contaminated cement, whose primary effect is the reduction in the cement shear strength. On the other hand, the test results presented in the study by Graham et al [46] indicated the positive effect of the suitable selection of the cement-mixing method (vacuum vs. manual) on the reduction of porosity, which were found to increase the crack resistance and its cyclic loading strength.…”