This study compares the strength of the native bone-cement bond and the old-new cement bond under cyclic loading, using third generation cementing technique, rasping and contamination of the surface of the old cement with biological tissue. The possible advantages of additional drilling of the cement surface is also taken into account. Femoral heads from 21 patients who underwent a total hip arthroplasty performed for hip arthritis were used to prepare bone-cement samples. The following groups of samples were prepared. A bone—cement sample and a composite sample of a 6 weeks old cement part attached to new cement were tested 24 hours after preparation to avoid bone decay. Additionally, a uniform cement sample was prepared as control (6 weeks polymerization time) and 2 groups of cement-cement samples with and without anchoring drill hole on its surface, where the old cement polymerized for 6 weeks before preparing composite samples and then another 6 weeks after preparation. The uniaxial cyclic tension-compression tests were carried out using the Zwick-Roell Z020 testing machine. The uniform cement sample had the highest ultimate force of all specimens (n = 15; Rm = 3149 N). The composite cement sample (n = 15; Rm = 902 N) had higher ultimate force as the bone-cement sample (n = 31; Rm = 284 N; p <0.001). There were no significant differences between composite samples with 24 hours (n = 15; Rm = 902 N) and 6 weeks polymerization periods (n = 22; Rm = 890 N; p = 0.93). The composite cement samples with drill hole (n = 16; Rm = 607 N) were weaker than those without it (n = 22; Rm = 890 N; p < 0.001). This study shows that the bond between the old and new cement was stronger than the bond between cement and bone. This suggests that it is better to leave the cement that is not loosened from the bone and perform cement in cement revision, than compromising bone stock by removal of the old cement with the resulting weaker cement-bone interface. The results support performing cement-in-cement revision arthroplasty The drill holes in the old cement mantle decrease cement binding strength and are not recommended in this type of surgery.
Introduction. Treatment of benign bone tumors and tumor-like lesions is undertaken by numerous Orthopedic surgeons worldwide. Several treatment modalities exist including curettage and bone grafting. CERAMENT is a novel bioresorbable bone substitute used for grafting. Aim. Assessment of preliminary result of treatment of benign bone tumors and tumors like lesions utilizing CERAMENT as a bone substitute. Analysis of therapeutic and diagnostic path and symptoms reported by patients with tumors and tumor-like lesions. Materials and methods. To the retrospective study 38 patients undergoing curettage and bone substitution with CERAMENT® BONE VOID FILLER were included (26% of them were females). We utilized patients’ history. Each patient had an X-ray in the twelfth month after surgery, which was analyzed using the modified Neer classification. The follow-up was 24 months. Results. The unicameral bone cyst was the most commonly encountered lesion (36.8%). Pain was the most common symptom reported (28.9%). Half of all cases were discovered accidentally on X-rays ordered for a different indication. Nearly a quarter of the cases (23.7%) were complicated by pathologic fracture. The distribution of scores in modified Neer score was as follow: SCORE I- 52.6% SCORE II- 15.8% SCORE III-10.6% SCORE IV-2.6%. Complications of procedure were noted in 18.4% of patients. 10.5% of patients had serious discharge from the operated site, 7.9% of patients had surgical wound infection. One case of recurrence was noted. Conclusions. Bone substitute – CERAMENT is suitable for use in the treatment of benign bone tumors and tumors like lesions. It is easy in application and is well tolerated by the patients. The problem is the relatively high rate of complications, mainly serous leakage from the wound.
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