Femoral component loosening in hip arthroplasty Cadaver study of subsidence and hoop strain

Manley, Michael; Stern, Lawrence S.; Kotzar, Geoffrey; Stulberg, Bernard N.

doi:10.3109/17453678709146384

Cited by 23 publications

(8 citation statements)

References 14 publications

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“…The highest incidence of cement failures occurs at the distal prosthesis [10,11,12,13,14]. These clinical findings have been explained by finite element analysis [15,16,17], and in vitro studies [18,19,20,21]. For amelioration of the cement mantle, distal centralizers have been reported to improve stem positioning and overall axial alignment [22,23].…”

Section: Introductionmentioning

confidence: 88%

“…Before cementing, the original prosthesis was completely inserted into the femur to exclude breakage of the distal centralizer or dislocation of the tube with the plug during final implantation. Standard canal irrigation was done with 500ml pressurized saline lavage (temperature, 20 C). For all stems Palacos R bone cement (80g) (Biomet-Merck, Berlin, Germany) was prechilled at 4 C. Room temperature was 20 C and atmospheric humidity was 60 % in the experimental operating rooms.…”

Section: Surgical Techniquementioning

confidence: 99%

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Modified cemented stem fixation in hip arthroplasty with computer based analysis – Experimental results

Barden

Wesskamp

Löer

et al. 2003

Materialwissenschaft Werkst

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27 cemented stems were implanted in fresh-frozen human cadaver femora with third generation antegrade cementing technique and with prechilled vacuum-mixed and pre-pressurized Palacos R bone cement. 3 groups with different implantation techniques were compared according to the achieved cement mantle thickness distribution. Group 1 (modified stem fixation): 7 canulated stems inserted over guidetubes that were fixed in distal synthetic plugs (3 Willert CF-30 and 4 flanged Charnley stems). The guidetubes served simultaneously for stem centralization and evacuation of the intramedullary cavity. Group 2: 12 stems with distal centralizers with fins (4 flanged Charnley, 8 anatomic cemented AC), and Group 3: 8 stems without centralizer (4 Willert CF-30 and 4 flanged Charnley). For analysis, each femur was cut into mean 25 cross-sections (range, 22 -31). Contact radiographs were taken and digitized with a sampling distance of 0.12mm (204.8 dpi). Using a custommade computer program (FemStat 1.001), the cement mantle thickness was determined at mean 650 implant surface points per cross section. Results: The percentage of critical cement mantle thickness was lower for the canulated stems with guidetube. Here 14.1 % of the measurements were smaller than 2mm. For the stems with distal centralizer and without centralizer this was 28.3 % and 28.2 % (p = 0.003 and p = 0.002, U-test). Cement mantles smaller than 1mm were also reduced for group 1 (2.8 % compared with 4.7 % and 7.5 %) but this was not significant (p = 0.384 and p = 0.094). The stems without centralizers had only slightly inferior cement mantles if compared to stems with distal centralizers with fins (for < 2mm p = 0.571, for < 1mm p = 0.305). Comparing different cementing techniques for one constant type of prosthesis (Charnley) the canulated stems with guide tubes provided a significantly better cement mantle thickness than the stems with distal centralizers (for < 2mm 10.3 % compared with 26.6 %, p = 0.029; for < 1mm 1.5 % compared with 3.4 %, p = 0.343). Distal centralizers failed, as the intramedullary cavity is elliptic in cross section and the gaps between the wings caused malposition. For all stems in group 3 improvement of the cement mantle thickness was predominantly achieved in the distal and middle third of the femur. Conclusion: The implantation technique with canulated stems inserted over a guidetube allows superior stem positioning leading to a more favourable cement mantle.Keywords: Hip arthroplasty, centralizer, cement, computer analysis 27 zementierte Hüftendoprothesen wurden in humane Autopsiefemora mit einer antegraden Zementiertechnik der dritten Generation implantiert. Vorgekühlter und vorkomprimierter Palacos-RKnochenzement wurde verwendet. Drei Gruppen mit verschiedenen Implantationstechniken wurden hinsichtlich der erreichten Zementmanteldicken-Verteilung untersucht. Der prozentuale Anteil der Messungen mit kritischem Zementmantel war bei den kanülierten Schäften (Gruppe 1) signifikant kleiner als bei den anderen Gruppen. Hier ergaben nur insg...

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Section: Introductionmentioning

confidence: 88%

Section: Surgical Techniquementioning

confidence: 99%

Modified cemented stem fixation in hip arthroplasty with computer based analysis – Experimental results

Barden

Wesskamp

Löer

et al. 2003

Materialwissenschaft Werkst

View full text Add to dashboard Cite

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“…3,11,12,21 To reduce experimental error in maintaining consistent ratios of abductor and hip joint reaction forces, the femur models were aligned such that the abductor force was resolved in hip joint load application. 12 The acetabular component was mounted with a 40°orientation to the load axis.…”

Section: Fatigue Test Setupmentioning

confidence: 99%

“…One-legged stance loading was achieved by mounting the constructs such that the loading axis was located at the center of the femoral head and through the center of the distal end of the construct. 3,11,21 A modified universal ball joint was mounted between the distal construct and the load cell, allowing free movement of the construct during loading. Proximal attachments to the MTS system were achieved by securing the acetabular component to the actuator of the MTS.…”

Section: Fatigue Test Setupmentioning

confidence: 99%

“…Since fatigue-related failures are most clinically relevant, fatigue testing of the models will yield data that is helpful to investigators who may want to utilize the analogue femur models or other analogue model types in environmentally controlled testing of surgical implant performance under high but biomechanically appropriate load-bearing conditions. 3,11,12,21,28 …”

Section: Introductionmentioning

confidence: 99%

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Fatigue Performance of Composite Analogue Femur Constructs under High Activity Loading

Chong¹,

Friis

Ballard

et al. 2007

Ann Biomed Eng

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Synthetic mechanical analogue bone models are valuable tools for consistent analysis of implant performance in both equilibrium and fatigue biomechanical testing. Use of these models has previously been limited by the poor fatigue performance when tested under realistic service loads. An objective was to determine whether a new analogue bone model (Fourth-Generation) using enhanced analogue cortical bone provides significantly improved resistance to high load fracture and fatigue as compared to the current (Third-Generation) bone models in clinically relevant in situ type testing of total hip implants. Six Third-Generation and six Fourth-Generation mechanical analogue proximal femur models were implanted with a cemented mock hip arthroplasty. Each specimen was loaded at 5 Hz in simulated one-legged stance under load control with a maximum compressive load of 2670 N and load ratio of 0.1. Average complete structural failure in Third-Generation femurs occurred at 3.16 million cycles; all specimens exhibited substantial displacement and crazing at well below 3 million cycles. In contrast, all Fourth-Generation femurs sustained 10 million cycles without complete structural failure and showed little change in actuator deflection. The Fourth-Generation femur model performance was sufficient to allow the model to be used in biomechanically relevant load bearing levels with an intramedullary device without model compromise that would affect test results.

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Interfacial properties of self-reinforced composite poly(methyl methacrylate)

Wright

Lautenschlager

Gilbert

1998

J. Biomed. Mater. Res.

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Total joint prostheses are often fixed in the bone using bone cement. The cement mantle, however, is prone to fatigue fracture that can lead to failure of the mantle, evolution of bone cement particles, and eventual loosening and failure of the prosthesis. A new material, self-reinforced composite poly(methyl methacrylate) (SRC-PMMA) was developed previously by the authors. This material has a similar chemical composition to bone cement, with the matrix and reinforcing fibers both fabricated from PMMA. One potential use for this material is as a precoat for hip prostheses or other stemmed prostheses. This study sought to examine the strength of the bonds that SRC-PMMA forms with simulated prostheses and bone cement. SRC-PMMA was woven about Co-Cr rods and push out tests were performed. Samples were tested in air as processed or after immersion in saline for 30 days at 37 degrees C. Three different weaves were investigated and compared to bone cement. Bone cement and SRC-PMMA formed interfacial bonds with Co-Cr rods that failed at an average load (stress) of 980 N (2.0 MPa). After saline immersion, the bone cement's interfacial bond strength was 642 N (1.23 MPa) and the tight weave SRC-PMMA was statistically stronger at 973 N (1.86 MPa). The shear strength within bone cement alone as measured by push out tests was an order of magnitude higher at 9210 N (15.2 MPa) in air and 9900 N (15.7 MPa) after saline immersion. The bond between SRC-PMMA and bone cement was 10,900 N (17.9 MPa) in air and 9610 N (15.8 MPa) after immersion in saline. Woven SRC-PMMA performed as well or better than bone cement in these push out tests.

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Femoral component loosening in hip arthroplasty Cadaver study of subsidence and hoop strain

Cited by 23 publications

References 14 publications

Modified cemented stem fixation in hip arthroplasty with computer based analysis – Experimental results

Modified cemented stem fixation in hip arthroplasty with computer based analysis – Experimental results

Fatigue Performance of Composite Analogue Femur Constructs under High Activity Loading

Interfacial properties of self-reinforced composite poly(methyl methacrylate)

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