Pressurization and Centralization Enhance the Quality and Reproducibility of Cement Mantles

Noble, Philip C.; Collier, Matthew B.; Maltry, John A.; Kamaric, Emir; Tullós, Hugh S.

doi:10.1097/00003086-199810000-00009

Cited by 56 publications

(29 citation statements)

References 29 publications

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“…During clinical insertion of a hip stem, the cement mantle can also be deteriorated by the intramedullary blood flow [35], which was not simulated in our model. In contrast to other reports [1,28,29], the beneficial effects of distal centralizers were not found in our study. This could result from the more accurate computer-assisted analysis of cross-sections in our series in contrast to the manual analysis of mere clinical radiographs Fig.…”

Section: Discussioncontrasting

confidence: 99%

“…By the wake that develops at the fins, air is also incorporated into the cement from the surrounding cancellous bone, as these regions are also known to contain air. Additionally the centralizers scratch along the bone bed and thus directly incorporate voids of hard and soft tissue particles and blood [1,28,29,30]. As a result of scratching, distal centralizer also fracture and dislocate from the prosthesis tip [28,26].…”

Section: Introductionmentioning

confidence: 99%

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Modified cemented stem fixation in hip arthroplasty with computer based analysis – Experimental results

Barden

Wesskamp

Löer

et al. 2003

Materialwissenschaft Werkst

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27 cemented stems were implanted in fresh-frozen human cadaver femora with third generation antegrade cementing technique and with prechilled vacuum-mixed and pre-pressurized Palacos R bone cement. 3 groups with different implantation techniques were compared according to the achieved cement mantle thickness distribution. Group 1 (modified stem fixation): 7 canulated stems inserted over guidetubes that were fixed in distal synthetic plugs (3 Willert CF-30 and 4 flanged Charnley stems). The guidetubes served simultaneously for stem centralization and evacuation of the intramedullary cavity. Group 2: 12 stems with distal centralizers with fins (4 flanged Charnley, 8 anatomic cemented AC), and Group 3: 8 stems without centralizer (4 Willert CF-30 and 4 flanged Charnley). For analysis, each femur was cut into mean 25 cross-sections (range, 22 -31). Contact radiographs were taken and digitized with a sampling distance of 0.12mm (204.8 dpi). Using a custommade computer program (FemStat 1.001), the cement mantle thickness was determined at mean 650 implant surface points per cross section. Results: The percentage of critical cement mantle thickness was lower for the canulated stems with guidetube. Here 14.1 % of the measurements were smaller than 2mm. For the stems with distal centralizer and without centralizer this was 28.3 % and 28.2 % (p = 0.003 and p = 0.002, U-test). Cement mantles smaller than 1mm were also reduced for group 1 (2.8 % compared with 4.7 % and 7.5 %) but this was not significant (p = 0.384 and p = 0.094). The stems without centralizers had only slightly inferior cement mantles if compared to stems with distal centralizers with fins (for < 2mm p = 0.571, for < 1mm p = 0.305). Comparing different cementing techniques for one constant type of prosthesis (Charnley) the canulated stems with guide tubes provided a significantly better cement mantle thickness than the stems with distal centralizers (for < 2mm 10.3 % compared with 26.6 %, p = 0.029; for < 1mm 1.5 % compared with 3.4 %, p = 0.343). Distal centralizers failed, as the intramedullary cavity is elliptic in cross section and the gaps between the wings caused malposition. For all stems in group 3 improvement of the cement mantle thickness was predominantly achieved in the distal and middle third of the femur. Conclusion: The implantation technique with canulated stems inserted over a guidetube allows superior stem positioning leading to a more favourable cement mantle.Keywords: Hip arthroplasty, centralizer, cement, computer analysis 27 zementierte Hüftendoprothesen wurden in humane Autopsiefemora mit einer antegraden Zementiertechnik der dritten Generation implantiert. Vorgekühlter und vorkomprimierter Palacos-RKnochenzement wurde verwendet. Drei Gruppen mit verschiedenen Implantationstechniken wurden hinsichtlich der erreichten Zementmanteldicken-Verteilung untersucht. Der prozentuale Anteil der Messungen mit kritischem Zementmantel war bei den kanülierten Schäften (Gruppe 1) signifikant kleiner als bei den anderen Gruppen. Hier ergaben nur insg...

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Modified cemented stem fixation in hip arthroplasty with computer based analysis – Experimental results

Barden

Wesskamp

Löer

et al. 2003

Materialwissenschaft Werkst

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“…The most important advances have been described in the cements and cementation techniques (Mulroy & Harris, 1990;Noble et al, 1998;Reading et al, 2000), and in the sterilization and manufacture of the prosthetic polyethylene Urries et al, 2004;D'Antonio et al, 2005;Oral et al, 2006;Faris et al, 2006;Gordon et al, 2006;Wolf et al, 2006). Nevertheless, the original stem design of Charnley remains unaltered and fully operational.…”

Section: Introductionmentioning

confidence: 99%

Simulation by Finite Elements of Bone Remodeling After Implantation of Femoral Stems

Gracia¹,

Ibarz²,

Cegoñino³

et al. 2012

Finite Element Analysis - From Biomedical Applications to Industrial Developments

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“…1,2 Strong evidence exists that debonding of the cement from the metallic stem, initiated as crack formation at interfacial voids, plays an important role in loosening. 3,4 Modern cementing techniques, such as vacuum mixing, centrifugation, pressurization, and retrograde filling with a cement gun, have been emphasized to reduce porosity and improve mechanical strength of the cement mantle, [5][6][7][8] but these efforts do not reduce porosity at the cementstem interface. 9 The probable cause for the preferential formation of voids at the interface is cement shrinkage during curing.…”

Section: Introductionmentioning

confidence: 99%

Precooling of the femoral canal enhances shear strength at the cement–prosthesis interface and reduces the polymerization temperature

et al. 2006

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Preheating of the femoral stem in total hip arthroplasty improves the cement-prosthesis bond by decreasing the interfacial porosity. The main concern, however, is the potential thermal osteonecrosis because of an increased polymerization temperature. In this study, the effects of femoral canal precooling on the characteristics of the cement-stem interface were evaluated in an experimental model for three test conditions: precooling of the femoral canal, preheating of the stem (448C), and a control in which stems were inserted at room temperature without thermal manipulation of the implant, cement, or bone. Compared to the control group, precooling of the femoral canal and preheating of the stem had similar effects on the cement-stem interface, with greater interfacial shear strength and a reduced porosity. Femoral canal precooling also produced a lower temperature at the cement-bone interface. No difference was found in the ultimate compressive strength of bone cement for the three preparation conditions. Based on this laboratory model, precooling of the femoral canal could improve shear strength and porosity at the stem-cement interface, minimize thermal injury, and maintain the mechanical strength of the cement. ß

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Pressurization and Centralization Enhance the Quality and Reproducibility of Cement Mantles

Cited by 56 publications

References 29 publications

Modified cemented stem fixation in hip arthroplasty with computer based analysis – Experimental results

Modified cemented stem fixation in hip arthroplasty with computer based analysis – Experimental results

Simulation by Finite Elements of Bone Remodeling After Implantation of Femoral Stems

Precooling of the femoral canal enhances shear strength at the cement–prosthesis interface and reduces the polymerization temperature

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