Factors Affecting the Cement Penetration of a Hip Resurfacing Implant: An in Vitro Study

Abstract

An understanding of how the cementing technique influences cement penetration is important for surgeons to plan and conduct hip resurfacing procedures. Therefore the aim of this study is to determine the influence of the following parameters on cement penetration: use of pulse lavage, type of cement, and the standing period of the cement. Nine fresh frozen paired whole cadaver femora were used to investigate cement penetration. The femora were divided into three paired groups: (A) compared the use of pulse lavage to no pulse lavage, (B) compared two low viscosity bone cements SULCEM-3 (Zimmer GmbH, Switzerland) and Surgical Simplex (Stryker Orthopaedics, USA), and (C) compared bone cement viscosities using standing times of 1.5 min. and 3 min. The Durom Hip Resurfacing implant (Zimmer GmbH, Switzerland) was used in all groups. A single slice was taken out of the center of each head. Cement penetration ratio (penetration area divided by the bone area enclosed by implant) and mean cement penetration depth were measured. Cement penetration is increased using pulse lavage, and has the tendency to increase with increasing the cement standing time from 1.5 to 3 min. No difference in cement penetration was found when different cement brands of comparable viscosity were used.

Preliminary Results of Implantation in Animal Model and Osteoblast Culture Evaluation of Prototypes of Biomimetic Multispiked Connecting Scaffold for Noncemented Stemless Resurfacing Hip Arthroplasty Endoprostheses

“… (a), (b) Exemplary cross-sections of three femoral heads with currently used RHAs, where the cups were fixed on femoral heads with the polymethacrylate cement (courtesy of Dr. S. Łazowski, Histopathomorphology Lab., Poznan, Poland); (c) cement pressing the trabecular marrow cavities occupies large volume (bright areas) of the femoral heads, sections showing cement penetration zone in femoral head occupying more than 1/3 of its volume in [4]. …”

“…The femoral head component of our prototype of innovating THRA endoprosthesis—designed to preserve the subcapsular arteriae retinacular: superior (3), anterior (4), and inferior (5); (1) a. circumflexa femoris lateralis, (2) ramus ascendens of (1); author's scheme based on the blood supply diagram from [4]. …”

“…On the one side, the use of cement provides sufficient primary fixation of RHA endoprosthesis femoral component, but on the other one the massive cement penetration into the proximal femoral epiphysis (it often occupies more than 1/3 of its volume, Figure 1, c.f. with [4]) causes regional blood supply insufficiency [5], which may lead to the progressive weakening of the internal bone microstructure and results in failures. Bone resorption, loosening (Figure 2(a)) at bone-cement-implant interface, and migration of the femoral component as well as the periprosthetic fractures (Figure 2(b)) were observed as postoperative complications in numerous clinical studies dealing with the current generation of RHA endoprostheses [6–20].…”

2008 Otto Aufranc Award: Component Design and Technique Affect Cement Penetration in Hip Resurfacing

“…Although a few studies have attempted to look at the cement mantle, these were limited to one implant design in which different cementation techniques were studied [14,17,22]. How implant design may influence cement mantle and penetration becomes important because mantle thickness and penetration plays a role in stress transfer to the underlying bone [39] with stress shielding still remaining a concern in terms of the long-term performance of hip resurfacing [10,21,44].…”

“…Furthermore, with cement used as the primary method of fixation on the femoral side [20], optimal cementing technique will inevitably vary between different centers representing, like in THA, a risk factor for early failure [15,19,36]. More importantly, how one achieves sufficient cement penetration in hip resurfacing is influenced by several factors [14,17,22,33], some of which can be controlled by the surgeon such as cement viscosity [33] and pulsatile lavage [22], whereas others such as femoral head bone quality [28] and implant design cannot be controlled.…”