Cement mantle defects in total hip arthroplasty: influence of stem size and cementing technique

Katzer, A.; Ince, Akif; Hahn, Moon Sik; Morlock, Michael M.; Steens, Wolfram

doi:10.1007/s10195-007-0084-x

Cited by 7 publications

(3 citation statements)

References 16 publications

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“…It can be difficult to achieve this in capacious Dorr-type C stovepipe femurs. There is little understanding regarding the distal cement mantle length and loosening [29,30]. Vancouver C-type injuries were associated in the current study with stovepipe femurs and low cortical thickness, and in these patients, cement mantle length did appear to play a role.…”

Section: Discussionmentioning

confidence: 49%

Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern

Powell-Bowns

Oag

Martín

et al. 2021

Arch Orthop Trauma Surg

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Introduction The aim of this study was to identify factors associated with the level of periprosthetic fracture involving a cemented polished tapered stem: Vancouver B or Vancouver C. Methods A retrospective cohort study of 181 unilateral periprosthetic fractures involving Exeter stems was assessed by three observers (mean age 78.5, range 39–103; mean BMI 27.1, 17–39; 97 (54%) male). Patient demographics, deprivation scores, BMI and time since primary prosthesis were recorded. Femoral diameter, femoral cortical thickness, Dorr classification and distal cement mantle length were measured from calibrated radiographs. Interobserver reliability was calculated using intraclass correlation coefficients (ICCs). Univariate and multivariate analysis was performed to identify associations with Vancouver B or C fractures. Results 160/181 (88%) Vancouver B and 21/181 (12%) Vancouver C-level fractures occurred at a mean of 5.9 ± 5.4 years (0.2–26.5) following primary surgery. Radiographic measurements demonstrated excellent agreement (ICC > 0.8, p < 0.001). Mortality was significantly higher following Vancouver C compared to B fractures: 90 day 14/160 Vs 5/21 (p = 0.05); 1 year 29/160 Vs 8/21 (p = 0.03). Univariate analysis demonstrated that Vancouver C fractures were associated with female sex, bisphosphonate use, cortical bone thickness, and distal cement mantle length (p < 0.05). On multivariate analysis, only female sex was an independent predictor of Vancouver C-level fractures (R2 =0.354, p = 0.005). Conclusion Most PFFs involving the Exeter stem design are Vancouver B-type fractures and appear to be independent of osteoporosis. In contrast, Vancouver C periprosthetic fractures display typical fragility fracture characteristics and are associated with female sex, thinner femoral cortices, longer distal cement mantles and high mortality.

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Section: Discussionmentioning

confidence: 49%

Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern

Powell-Bowns

Oag

Martín

et al. 2021

Arch Orthop Trauma Surg

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“…But the size of the pore and their distribution are expected to strongly affect the fracture strength if some of the pores exceed the critical flaw size for PMMA (John et al 2007). Pores at the interface between the cement and femoral stem can also act as sites of stress concentration, with the potential for crack emanating from micropores initiation; the number of these pores can be decreased by preheating the femoral stem , Spears et al 2001, Katzer et al 2008, but the interaction between these defects has not been studied too, which is the aim of our work. These defects can also act as sites of stress concentration which the level reaches or exceeds, locally, the tensile strength of the cement (Murphy and Prendergast 2001): see Fig.…”

Section: Introductionmentioning

confidence: 99%

Effect of cavity-defects interaction on the mechanical behavior of the bone cement

Zouambi¹,

Sérier²,

Benamara³

2014

Advances in materials Research

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The presence of cavities in the bone cement has a great importance for the transport of antibiotics, but its existence in this material can lead to its weakening by notch effect. The aim of this study allows providing a physical interpretation to the cavities interconnection by cracks observed experimentally. The most important stress of Von Mises is localized at the cement/bone interface near the free edge which is the seat of stress concentration. The presence and interaction of cavities in this site concentrate, by notch effect, stresses which tend to the tensile fracture stress of Bone cement.

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“…Most cracks in cement mantle were originated from pores in bone cement, which results in loosening of prosthesis. Cementing technique, like vacuum mixing, reduces 70–80% pore area compared with non-vacuum mixing 3 . It was observed that with increase in the penetration depth the stresses at bone/bone cement also increased.…”

Section: Introductionmentioning

confidence: 99%

Effect of cement fill ratio in loosening of hip implants

Gunn

Gundapaneni²,

Goswami³

2012

Biomatter

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Femoral loosening is one of the most prevalent causes of revision orthopedic surgeries. Cement mantle thickness has been directly correlated with femoral loosening. If the mantle is too thick, there is an increased risk of radiolucent lines and inconsistent densities. Also, the more bone that is reamed out during the procedure can lead to instability, especially if the quality of the bone is compromised due to osteoporosis. Too thin of a mantle can lead to a higher probability for cement fracture, loosening the prosthetic even further. This study has shown that there is an ideal thickness range between two to five that should be kept. From radiographic images one can measure the thickness of the cement mantle showing the loosening characteristics.

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Cement mantle defects in total hip arthroplasty: influence of stem size and cementing technique

Abstract: The cause of isolated osteolysis in the femoral shaft around stem implants in patients with cemented THR has so far not been established.

Cited by 7 publications

References 16 publications

Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern

Vancouver B and C periprosthetic fractures around the cemented Exeter Stem: sex is associate with fracture pattern

Effect of cavity-defects interaction on the mechanical behavior of the bone cement

Effect of cement fill ratio in loosening of hip implants

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