The initiation of failure in cemented femoral components of hip arthroplasties

Jasty, Murali; Maloney, W J; Bragdon, C.R.; O'Connor, D.O.; Haire, Teresa; Wh, Harris

doi:10.1302/0301-620x.73b4.2071634

Cited by 507 publications

(335 citation statements)

References 14 publications

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“…Through-cracks may be most deleterious because debris could be transported from the stemxement interface to the cement-bone junction, resulting in an osteolytic response. The results were also similar to retrieval studies where cracks, emanating from the stem, were often associated with sharp corners in the stem geometry [8,9,19]. This suggests that crack initiation and propagation may be very dependent on local geometry of the stem in the vicinity of the crack [15].…”

Section: Discussionsupporting

confidence: 84%

Fatigue crack growth rate does not depend on mantle thickness: an idealized cemented stem construct under torsional loading

Hertzler

Miller

Mann

2002

Journal Orthopaedic Research

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Retrieval studies indicate that cemented stem loosening in femoral components of total hip replacement can initiate at the stemcement interface. The etiology of the crack propagation process from the stem-cement interface is not well understood, but cracks are typically associated with thin cement mantles. In this study, a combination of experimental and computational methods was used to investigate the fatigue crack propagation process fi-om the stern-PMMA cement interface using a novel torsional loading model. Constructs with thin ( I mm). medium (3 mm) or thick (7 mm) cement mantles were evaluated. Crack growth was stable for all cases and the rate of crack growth diminished with increasing crack length. Crack growth rate did not depend on mantle thickness ( p > 0.05) over the first 1 mm of crack length, but cracks in thin mantles reached the full thickness of the mantle in the fewest number of loading cycles. The fracture mechanics-based finite element models indicated decreased stress intensity factors with increasing crack length and were consistent with the experimental findings. When combined with a fatigue crack growth Paris-law for PMMA cement. the finite element models provided reasonable predictions of the crack growth process.

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Section: Discussionsupporting

confidence: 84%

Fatigue crack growth rate does not depend on mantle thickness: an idealized cemented stem construct under torsional loading

Hertzler

Miller

Mann

2002

Journal Orthopaedic Research

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“…Aseptic loosening remains the most important cause of long-term implant failure according to registry reports [19]. Uncemented implants were developed to achieve biological implant-bone fixation and reduce long-term failures resulting from aseptic loosening, which occurred with the first-generation cementing techniques [29] and in some later-generation cemented stem designs [34], a particular problem with young patients. The first generation of uncemented implants showed mixed survivorship with problems related to fixation failure, thigh pain, stress Cumulative Survival (%) Fig.…”

Section: Discussionmentioning

confidence: 99%

Long-term (20- to 25-year) Results of an Uncemented Tapered Titanium Femoral Component and Factors Affecting Survivorship

Streit¹,

Innmann²,

Merle³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade. Questions/purposes We evaluated (1) survivorship using femoral revision for any reason as the end point; (2) survivorship using femoral revision for aseptic loosening as the end point; and (3) patient-related and surgical risk factors for aseptic stem loosening at a minimum 20-year followup with an uncemented tapered titanium stem.Methods We reviewed the clinical and radiographic results of 354 THAs in 326 patients performed between January 1985 and December 1989 using an uncemented grit-blasted, tapered titanium femoral stem. Mean age at surgery was 57 years (range, 13-81 years). Kaplan-Meier survivorship analysis was used to estimate long-term survival. Minimum followup evaluation was 20 years (mean, 22 years; range, 20-25 years); at that time, 120 patients (127 hips) had died, and four patients (five hips) were lost to followup. Multivariate survival analysis using a Cox regression model was performed. Results Survivorship at 22 years with revision of the femoral component for any reason as the end point was 86% (95% confidence interval [CI], 81%-90%). Survivorship for femoral revision for aseptic loosening as the end point was 93% at 22 years (95% CI, 90%-96%). Undersized stems (canal fill index B 80%) and stems in hips with cup revision were at higher risk for aseptic loosening (hazard ratio, 4.2 and 4.3, respectively). There was a high rate of acetabular revision in this series (38%), mostly related to smooth-threaded, cementless sockets. Conclusions Uncemented femoral fixation was reliable into the third decade. Age, male sex, and diagnosis were not associated with a higher risk of aseptic loosening.

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“…One way to avoid these stress elevations is to prevent stem debonding. However, whether a permanent stem-cement bond can be obtained remains questionable, and debonding seems a rule rather than an exception [7][8][9]. The alternative to this concept is to accept that stem-cement debonding does occur, and minimize its effect.…”

Section: Introductionmentioning

confidence: 99%

Surface roughness of debonded straight-tapered stems in cemented THA reduces subsidence but not cement damage

Verdonschot

Huiskes

1998

Biomaterials

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Although stress analyses have shown that the mechanical endurance of cemented femoral THA reconstructions is served by stems that firmly bond to their cement mantles, retrieval studies suggest that this may be difficult to achieve. Clinical studies with roentgen stereophotogrammetric analyses have shown that stems may gradually debond from their cement mantle. Accepting the fact that stem debonding is unavoidable, stem subsidence and cement stresses can be reduced by increasing stem-cement friction, as indicated by finite element stress analyses. Hence, it can be hypothesized that debonded stems with high surface roughness values would damage the cement mantle to a lesser extent as compared to polished ones. To confirm this hypothesis, tapered stems with polished and rough surface finishes were implanted in cement mantles and cyclically loaded for 1.7 million times. It was investigated how surface roughness affected the damage in the cement mantle, and how it was related to prosthetic subsidence.The polished taper subsided considerably more than the rough one (630 vs. 270 m at the end of the experiments). In addition, it was found that the polished taper displayed step-wise subsidence, which is probably due to the interaction of stick-slip processes at the interface, associated with creep of the acrylic cement. The rough taper subsided monotonously. Scanning Electron Microscopic (SEM) analysis of the taper-cement structures showed that the rough taper was completely debonded from the cement mantle, creating a gap at the interface, and that many large cement cracks and particles were created. Around the polished taper, only a few cracks were found and the taper-cement interface seemed undamaged.It was concluded that an increased surface roughness does not necessarily lead to a reduction in cement damage. On the contrary, compared to polished ones, debonded rough stems may produce more cement cracks and acrylic cement debris, and provide routes to transport these wear products. Hence, after failure of the stem-cement interface, straight-tapered stems with an increased surface roughness accelerate the failure process due to inferior fail-safe features. Consequently, in vivo subsidence patterns at the stem-cement interface should be considered in combination with the surface finish of the implant. An amount of post-operative subsidence of a rough stem may be much more damaging for the reconstruction than the same amount for a polished stem.

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The initiation of failure in cemented femoral components of hip arthroplasties

Cited by 507 publications

References 14 publications

Fatigue crack growth rate does not depend on mantle thickness: an idealized cemented stem construct under torsional loading

Fatigue crack growth rate does not depend on mantle thickness: an idealized cemented stem construct under torsional loading

Long-term (20- to 25-year) Results of an Uncemented Tapered Titanium Femoral Component and Factors Affecting Survivorship

Surface roughness of debonded straight-tapered stems in cemented THA reduces subsidence but not cement damage

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