Enhancement of initial stability of press-fit femoral stems using injectable calcium phosphate cement: an in vitro study in dog bones

Ooms, E.M.; Wolke, Joop G.C.; Wijdeven, W.S.J. van de; Willems, Marieke M M; Schoenmaker, M.F.; Jansen, John A.

doi:10.1016/j.biomaterials.2003.10.067

Cited by 9 publications

(6 citation statements)

References 42 publications

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“…Thus, current true torsional strengths were 40.5 Nm (SSS), 7.9 Nm (SLS), 9.3 Nm (GSS), and 7.8 Nm (GLS), two of which are below data from Taylor et al Bone ingrowth after 6 weeks post surgery, the use of calcium phosphate cement as a femur-stem gap filler, and the introduction of locking bolts into press-fit stem designs may increase torsional strength beyond that measured currently. 24,25,33 It should be noted, however, that the femur-stem interface may possibly only experience these torque levels once the femur-TKR bond itself has failed due perhaps to distal femur bone degeneration that necessitated or followed the initial TKR revision surgery.…”

Section: Discussionmentioning

confidence: 99%

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

Zdero

Saidi

Mason

et al. 2012

Proc Inst Mech Eng H

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Few biomechanical studies exist on femoral cementless press-fit stems for revision total knee replacement (TKR) surgeries. The aim of this study was to compare the mechanical quality of the femur–stem interface for a series of commercially available press-fit stems, because this interface may be a ‘weak link’ which could fail earlier than the femur–TKR bond itself. Also, the femur–stem interface may become particularly critical if distal femur bone degeneration, which may necessitate or follow revision TKR, ever weakens the femur–TKR bond itself. The authors implanted five synthetic femurs each with a Sigma Short Stem (SSS), Sigma Long Stem (SLS), Genesis II Short Stem (GSS), or Genesis II Long Stem (GLS). Axial stiffness, lateral stiffness, ‘offset load’ torsional stiffness, and ‘offset load’ torsional strength were measured with a mechanical testing system using displacement control. Axial (range = 1047–1461 N/mm, p = 0.106), lateral (range = 415–462 N/mm, p = 0.297), and torsional (range = 115–139 N/mm, p > 0.055) stiffnesses were not different between groups. The SSS had higher torsional strength (863 N) than the other stems (range = 167–197 N, p < 0.001). Torsional failure occurred by femoral ‘spin’ around the stem’s long axis. There was poor linear correlation between the femur–stem interface area versus axial stiffness (R = 0.38) and torsional stiffness (R = 0.38), and there was a moderate linear correlation versus torsional strength (R = 0.55). Yet, there was a high inverse linear correlation between interfacial surface area versus lateral stiffness (R = 0.79), although this did not result in a statistical difference between stem groups (p = 0.297). These press-fit stems provide equivalent stability, except that the SSS has greater torsional strength.

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Section: Discussionmentioning

confidence: 99%

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

Zdero

Saidi

Mason

et al. 2012

Proc Inst Mech Eng H

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“…When running or climbing stairs, hip loading is supposedly higher [35]. Given that the forces on the human hip can increase to 2-3 times body weight, we accounted for sufficient loading by applying a maximal force of 1000 N to the dog bone (i.e., 3 times body weight [36]).…”

Section: Discussionmentioning

confidence: 99%

Initial stability of a new uncemented short-stem prosthesis, Spiron®, in dog bone

Wiebking

Birkenhauer²,

Krettek

et al. 2011

THC

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Background: Use of the proximal part of the femur in total hip arthroplasty enables preservation of the distal femur for later revisions. To use this advantage, different types of short-stem prosthesis have been developed in recent years. Although cementless hip arthroplasty is not common in the treatment of canine osteoarthritis, the use of cementless short-stems might be an alternative therapy. The new cementless short-stem prosthesis called Spiron is self-tapping, and is constructed with a conical shape with threads. We measured the relative motion in the bone/prosthesis interface with specified loads in the femora of dogs to investigate two aspects: the primary stability of two systems of uncemented prosthesis with different principles of anchoring, and the theoretical use of the Spiron in dog bone. We measured the cyclic behaviour (i.e., reversible, elastic), subsidence (i.e., irreversible, plastic, migration) and maximal applied load.Methods: Twenty-four pairs of fresh femur bones from adult German shepherd dogs were used. After measuring the total bone mineral density (TBMD), 16 bones were used in each of the short-stem prosthesis group (group A), the Zweymuller prosthesis group (group B), and the no-prosthesis control group (group C). Micromotion between bone and prostheses was measured for 16,200 N axial load steps, beginning with 200 N and increasing to 3000 N (1600 cycles/femur). Simple analysis of variance and non-parametric tests were used to compare the groups.Results: The Spiron prosthesis had significantly less motion in the bone/prosthesis interface compared with the Zweymuller prosthesis.Conclusions: The new principle of anchoring of the Spiron short-stem prosthesis may provide higher primary stability compared with conventional techniques. The findings of this study support the assumption that the use of the Spiron prosthesis to treat osteoarthritis in the dog is feasible.

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“…Prefabricated blocks are difficult to shape, resulting in poor filling of the bone defect, while granules do not provide the dimensional stability and can easily migrate into the surrounding tissue. A solution for these problems can be CaP cement that can be shaped according to the defect dimension and harden in situ [1][2][3][4][5][6][7][8][9]. The injectable CaP cement as used in this study consists of a mixture of powder and liquid.…”

Section: Introductionmentioning

confidence: 99%

Mechanical evaluation of implanted calcium phosphate cement incorporated with PLGA microparticles

et al. 2006

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In this study, the mechanical properties of an implanted calcium phosphate (CaP) cement incorporated with 20wt% poly (dl-lactic-co-glycolic acid) (PLGA) microparticles were investigated in a rat cranial defect. After 2, 4 and 8 weeks of implantation, implants were evaluated mechanically (push-out test) and morphologically (Scanning Electron Microscopy (SEM) and histology). The results of the push-out test showed that after 2 weeks the shear strength of the implants was 0.44+/-0.44MPa (average+/-sd), which increased to 1.34+/-1.05MPa at 4 weeks and finally resulted in 2.60+/-2.78MPa at 8 weeks. SEM examination showed a fracture plane at the bone-cement interface at 2 weeks, while the 4- and 8-week specimens created a fracture plane into the CaP/PLGA composites, indicating an increased strength of the bone-cement interface. Histological evaluation revealed that the two weeks implantation period resulted in minimal bone ingrowth, while at 4 weeks of implantation the peripheral PLGA microparticles were degraded and replaced by deposition of newly formed bone. Finally, after 8 weeks of implantation the degradation of the PLGA microparticles was almost completed, which was observed by the bone ingrowth throughout the CaP/PLGA composites. On basis of our results, we conclude that the shear strength of the bone-cement interface increased over time due to bone ingrowth into the CaP/PLGA composites. Although the bone-cement contact could be optimized with an injectable CaP cement to enhance bone ingrowth, still the mechanical properties of the composites after 8 weeks of implantation are insufficient for load-bearing purposes.

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Enhancement of initial stability of press-fit femoral stems using injectable calcium phosphate cement: an in vitro study in dog bones

Cited by 9 publications

References 42 publications

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

A biomechanical comparison of four different cementless press-fit stems used in revision surgery for total knee replacements

Initial stability of a new uncemented short-stem prosthesis, Spiron®, in dog bone

Mechanical evaluation of implanted calcium phosphate cement incorporated with PLGA microparticles

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