The Influence of a Suction Device on Fixation of a Cemented Cup using RSA

Abstract

The quality of technique used at the time of socket cementation is crucial in ensuring a durable longterm result of the implant. We asked whether a new instrument, an aspirator retractor introduced into the wing of the ilium before socket preparation and cementation, would enhance cement fixation as defined by RSA and radiographic examination. We randomized 38 patients into two groups. The surgical technique was identical between the groups with the exception of the use of the aspirator retractor. Patients were followed clinically and with radiostereometry at a minimum of 2 years. We compared gross radiographic appearances, including the depth of penetration of cement and the incidence of postoperative and 2-year radiolucent lines. There was no difference in proximal migration between the two groups. No improvement of fixation was proven from the measured translations and rotations of the socket in the suction group. We found no difference in the number or extent of radiolucent lines or the depth of cement penetration when the iliac suction device was used in conjunction with contemporary cementing techniques. Although the data suggest no shortterm advantage in this small study, we will continue to follow these patients presuming there will be improved outcomes in the longer term and since the device provides an easier method of obtaining adequate fixation, especially if technical difficulties are encountered during the pressurization procedure.

Benefits of Using Modern Cementing Techniques in the Acetabulum: The Rim Cutter

“…Thus, prevention of zone-1 radiolucency is of paramount importance. 26 To reduce the occurrence of radiolucent lines, drilling penetration holes for the cement, cleansing the bone bed of marrow and debris by pulsatile lavage, 27 minimising bleeding by the use of hypotensive anaesthesia, careful haemostasis with hydrogen peroxide solution 28 or adrenaline 29 using a sucker aspirator, 10,30 and prolonged application of a proprietary pressuriser 31 have all been recommended. As injection pressure of the cement is lower in the acetabulum than in the femur, the same inter-digitation cannot be achieved.…”

“…The iliac sucker was used in the wing of the acetabulum to enhance cement penetration and clear blood from the cement-bone interface. 2,[9][10][11] The socket was then inserted 5 to 7 minutes after mixing of the Simplex cement at 20ºC, using the introducer and an axial pusher to drive the socket into the seated position. A greater force was needed to seat the cup as the flange approached the rim, because the pressure rose within the cement behind the cup.…”

What is the Optimum Pattern of Pressurisation to Gain Maximum Penetration of Methylmethacrylate Cement into the Reamed Acetabulum?

“…Although fixation of the femoral component has been improved by compression of cement at low viscosity into restricted clean dry bone, there has been disproportionately little research on acetabular cementing technique. Keyholes were adopted to promote interference between cement and bone, and cement penetration into these enhanced by gunning in low viscosity cement at high pressure, and negative pressure from iliac suction and positive pressure from flanged cups have been introduced; however, clinical results have not significantly improved [1,[6][7][8][9][10][11].…”

Acetabular Subchondral Bone Decortication and Its Role in the Outcome of Cemented Total Hip Replacement in Young Patients

“…Cemented total hip arthroplasty (THA) is a globally successful intervention 1) . Long-term results for cemented implants has shown increased implant longevity and improved outcomes 1 2 3) . Long-term results have also demonstrated that the most widespread cause of failure is aseptic loosening 4 5) .…”

“…Optimization of the acetabular bone surface preparation has been recognized as an important process of generating a solid bone-cement interface 12 13) . The mechanism of action of this secure cementation technique is believed to prevent early fluid and debris penetration 3 12) . A wide spread method to achieve cemented acetabular fixation has been the introduction of reaming with retention of the subchondral bone plate (SCBP) for improved stability of fixation 14 15) .…”