Cement interface temperature in hip arthroplasty

Toksvig‐Larsen, Sören; Franzén, Herbert; Ryd, Leif

doi:10.3109/17453679108999232

Cited by 96 publications

(48 citation statements)

References 20 publications

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“…Conversely, the peak bone temperature predicted by our thin mantle models were in the same range as those reported for cemented THA 29 and vertebroplasty in goats. 30 Correspondingly, no thermal damage was predicted.…”

Section: Discussionmentioning

confidence: 99%

“…But in both procedures the bulk cement volume was quite small; the cement mantle thickness typically is 2-3 mm for cemented THA, while on average 0.8 ml of cement was used for the vertebroplasty in goats. 30 Consequently, the interface temperatures remained low. In our worst case model the volume of bulk cement was much higher (15 ml), resulting in a higher peak temperature and the prediction of thermal necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Verlaan et al 29 and Toksvig-Larsen et al 30 measured the temperature at the cement-bone interface in vivo in cemented THA in humans and vertebroplasty in goats, respectively. In both studies no evidence for thermal necrosis was found.…”

Section: Discussionmentioning

confidence: 99%

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Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty—a numerical study

Janssen

Scheerlinck

2011

Journal Orthopaedic Research

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Femoral fractures within resurfacing implants have been associated with bone necrosis, possibly resulting from heat generated by cement polymerization. The amount of heat generated depends on cement mantle volume and type of cement. Using finite element analysis, the effect of cement type and volume on thermal necrosis was analyzed. Based on CT-data of earlier implantations, two different models were created: a thick mantle model, representing a low-viscosity ''cement filling'' technique, and a thin mantle model, representing a high viscosity ''cement packing'' technique. Six cement types were analyzed. The polymerization heat generation and its effect on bone necrosis were predicted. In the thin cement mantle models, no thermal necrosis was predicted. Thick cement mantle models produced thermal necrosis at the cement-bone interface depending on cement type. In the worst case, 6% of the bone at the cement-bone interface became necrotic, covering almost the entire cross-sectional area. The current findings suggest a potential thermal drawback of thick cement mantles, although it is unclear whether thermal bone necrosis significantly affects implant fixation or increases the fracture risk. Furthermore, our study showed distinct differences between the heat generated and resulting thermal damage caused by the various cement types. Keywords: finite element analysis; bone cement; thermal necrosis; hip resurfacing arthroplasty Hip resurfacing arthroplasty is an alternative for total hip arthroplasty (THA), with the proposed benefits of bone stock preservation and increased stability. The most common causes for revision of resurfacing arthroplasty are fracture, loosening, and lysis. 1 Although most fractures occur at the implant rim, 20% occur within the femoral component. 2 These fractures have been associated with bone necrosis, 3 often occurring in the bone-cement interface region. It has been hypothesized that this necrotic layer is caused by heat generated by polymerizing bone cement, inducing thermal damage to the bone. 4 Since polymerization of bone cement is an exothermic reaction, the amount of heat generated is proportional to its volume. As a result, hip resurfacings with larger amounts of cement in the femoral head display more fibrous tissue at the cement-bone interface. 5,6 The size and shape of the cement mantle depends on the cementing technique and the type of cement. [7][8][9] The use of low viscosity cement poured into the femoral component 10 leads to a relatively deep cement penetration into the femoral head, 7-9 and a large total cement volume especially when anchoring holes are used. 8 In contrast, when high viscosity cement is manually applied to the femoral head, a more homogeneous, thinner cement mantle is obtained. 8,11 Another factor affecting the temperature rise is the polymerization properties of the cement. 12,13 A fast polymerizing cement will cause a higher peak temperature that will last for a short time, while slower polymerizing cement will cause a lower peak temperature t...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty—a numerical study

Janssen

Scheerlinck

2011

Journal Orthopaedic Research

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“…Nevertheless, the results of the cadaver experiments for the PE cup acquired in this study are consistent to a certain extent with in vivo experiments, 33 which showed median maximum temperatures of 49°C (41°C to 67°C) in the uncooled condition and 41°C (37°C to 48°C) in the cooled condition (Table 3). In another in vivo study, 34 the mean curing temperature for PE cups was 43°C. An explanation for the difference could be that the initial mean acetabulum temperature was reported at 32°C instead of 37°C body temperature.…”

Section: Limitationsmentioning

confidence: 99%

Influence of Cooling on Curing Temperature Distribution During Cementing of Modular Cobalt-Chromium and Monoblock Polyethylene Acetabular Cups

et al. 2013

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Total hip replacements for older patients are usually cemented to ensure high postoperative primary stability. Curing temperatures vary with implant material and cement thickness (30°C to 70°C), whereas limits for the initiation of thermal bone damage are reported at 45°C to 55°C. Thus, optimizing surgical treatment and the implant material are possible approaches to lower the temperature. The aim of this study was to investigate the influence of water cooling on the temperature magnitude at the acetabulum cement interface during curing of a modular cobalt-chromium cup and a monoblock polyethylene acetabular cup. The curing temperature was measured for SAWBONE and human acetabuli at the cement-bone interface using thermocouples. Peak temperature for the uncooled condition reached 70°C for both cup materials but was reduced to below 50°C in the cooled condition for the cobalt-chromium cup (P = .027). Cooling is an effective method to reduce curing temperature with metal implants, thereby avoiding the risk of thermal bone damage.

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“…Unfortunately, an inherent problem of this reaction is the great amount of heat released during the bone cement preparation, which may cause the reaction temperature to increase above 100°C, possibly leading to irreparable damage of living tissues (Pascual et al, 1996). However, alternative preparation procedures have been suggested in order to reduce the high temperatures that may be reached during the bone cement preparation, such as the reduction of the operating room temperature (Meyer et al, 1973), the manipulation of the MMA / PMMA ratio (Haas et al, 1975) and the usage of cold chemicals (Dipisa et al, 1976;Toksvig-Larsen et al, 1991;Maffezzoli, 1997).…”

Section: Introductionmentioning

confidence: 99%

Production of bone cement composites: effect of fillers, co-monomer and particles properties

Santos¹,

Pita²,

Melo³

et al. 2011

Braz. J. Chem. Eng.

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-Artificial bone cements (BCs) based on poly(methyl methacrylate) (PMMA) powders and methyl methacrylate (MMA) liquid monomer also present in their formulation small amounts of other substances, including a chemical initiator compound and radiopaque agents. Because inadequate mixing of the recipe components during the manufacture of the bone cement may compromise the mechanical properties of the final pieces, new techniques to incorporate the fillers into the BC and their effect upon the mechanical properties of BC pieces were investigated in the present study. PMMA powder composites were produced insitu in the reaction vessel by addition of X-ray contrasts to the reacting MMA mixture. It is shown that this can lead to much better mechanical properties of test pieces, when compared to standard bone cement formulations, because enhanced dispersion of the radiopaque agents can be achieved. Moreover, it is shown that the addition of hydroxyapatite (HA) and acrylic acid (AA) to the bone cement recipe can be beneficial for the mechanical performance of the final material. It is also shown that particle morphology can exert a tremendous effect upon the performance of test pieces, indicating that the suspension polymerization step should be carefully controlled when optimization of the bone cement formulation is desired.

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Cement interface temperature in hip arthroplasty

Cited by 96 publications

References 20 publications

Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty—a numerical study

Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty—a numerical study

Influence of Cooling on Curing Temperature Distribution During Cementing of Modular Cobalt-Chromium and Monoblock Polyethylene Acetabular Cups

Production of bone cement composites: effect of fillers, co-monomer and particles properties

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