Femoral cementing technique for hip resurfacing arthroplasty

Abstract

The resurgence of metal-metal bearings has renewed interest in hip resurfacing, but a paucity of information exists regarding femoral cementing technique. We developed a laboratory model in which 72 open-cell foam specimens were used to simulate bone. Analyses of two cement viscosities, two foam porosities, and six cementing techniques were performed: manual cement application only, manual application and filling of one quarter of the component with cement, filling of half of the component, manual application and half component filling, full component filling, and manual application and full component filling. For manual application, cement was pressurized into the foam by rolling the finger tips. For component filling, a defined quantity of cement was poured into the component before pressing it onto the foam. Specimens were cut into quarters, and cement penetration was quantified in seven areas: top, chamfer, wall, interior area, and proximal, medial, and distal stem. The manual technique showed a 3-mm thick, even cement penetration of the outer fixation surface (top ¼ 26 AE 0 mm 2 , chamfer ¼ 14.9 AE 0.2 mm 2 , wall ¼ 55.6 AE 5.2 mm 2 ). None of the other techniques showed a significantly higher penetration in these areas. Large differences were found between all techniques at the medial stem (27.7 AE 17.5 mm 2 , p < 0.001) and the interior area (128.5 AE 69.6 mm 2 , p ¼ 0.013). An increasing degree of penetration occurred from manual cement application to manual application and full component filling. Sixteen specimens showed incomplete seating, which occurred with all techniques except the manual technique. The manual technique consistently gave an approximately 3-mm thick even cement penetration over the outer fixation area. Pouring any cement into the shell resulted in variable degrees of deeper penetration and a risk of incomplete seating, which have been associated with bone necrosis and early fracture.

2008 Otto Aufranc Award: Component Design and Technique Affect Cement Penetration in Hip Resurfacing

“…9) (Table 4). This is in accordance with the findings of Bitsch and associates [14], which noted a thicker cement mantle at the dome using the ASR1 component, which has a conical design like the BHR, especially when cement was poured in the femoral shell as part of the cementation technique. We also recorded a major difference in cement mantle thickness with the ReCAP1 having the thicker mantle and the Du-ROM1 the thinnest mantle with all of the implants being fully seated, again emphasizing the influence of implant design because the ReCAP1 is the only implant without a chamfer design being purely spherical.…”

“…Although a few studies have attempted to look at the cement mantle, these were limited to one implant design in which different cementation techniques were studied [14,17,22]. How implant design may influence cement mantle and penetration becomes important because mantle thickness and penetration plays a role in stress transfer to the underlying bone [39] with stress shielding still remaining a concern in terms of the long-term performance of hip resurfacing [10,21,44].…”

“…Furthermore, with cement used as the primary method of fixation on the femoral side [20], optimal cementing technique will inevitably vary between different centers representing, like in THA, a risk factor for early failure [15,19,36]. More importantly, how one achieves sufficient cement penetration in hip resurfacing is influenced by several factors [14,17,22,33], some of which can be controlled by the surgeon such as cement viscosity [33] and pulsatile lavage [22], whereas others such as femoral head bone quality [28] and implant design cannot be controlled.…”

Influence of bone density on the cement fixation of femoral hip resurfacing components

“…[15][16][17][18] The importance of cementing technique has been recognized. [8][9][10]19 Aberrancies in cementing technique and insertion trauma have been implicated in early femoral-side resurfacing failures. 20,21 But effort has also been made to find useful patient selection criteria.…”

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

“…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.…”