Modified femoral pressuriser generates a longer lasting high pressure during cement pressurisation

Abstract

BackgroundThe strength of the cement-bone interface in hip arthroplasty is strongly related to cement penetration into the bone. A modified femoral pressuriser has been investigated, designed for closer fitting into the femoral opening to generate higher and more constant cement pressure compared to a commercial (conventional) design.MethodsFemoral cementation was performed in 10 Sawbones® models, five using the modified pressuriser and five using a current commercial pressuriser as a control. Pressure during the cementation was recorded at the proximal and distal regions of the femoral implant. The peak pressure and the pressure-time curves were analysed by student's t-test and Two way ANOVA.ResultsThe modified pressuriser showed significantly and substantially longer durations at higher cementation pressures and slightly, although not statistically, higher peak pressures compared to the conventional pressuriser. The modified pressuriser also produced more controlled cement leakage.ConclusionThe modified pressuriser generates longer higher pressure durations in the femoral model. This design modification may enhance cement penetration into cancellous bone and could improve femoral cementation.

Pre-bending a dynamic compression plate significantly alters strain distribution near the fracture plane in the mid-shaft femur

“…Thus, these femoral analogs have been used extensively in orthopedic research. 20–24 The specific analog used in the current study was also chosen because it represented the organic shape of the femur. This likely lead to more realistic results versus the use of cylindrical tubes to represent the femoral diaphysis.…”

Comparison of Two Pressurisers for Cementation of the Proximal Femur

“…9 A modified seal designed to sit 5 to 6 mm within the proximal femur enables a better seal and improves cementation pressures. 6 The proximal cancellous bone covered by the seal would have poorer cement penetration, but this was felt to be negligible compared with the improved pressurisation that was obtained. 6 However, we believe that implant fixation and cement mantle quality around the proximal femur is essential, and an extramedullary seal can achieve even higher pressure.…”

“…4 Peak pressure is also greater with the use of a cement gun than with finger packing (156.9 vs. 81.1 kPa), 5 and greater pressures can be attained with the addition of proximal femoral pressurisers (up to 300 kPA). 6 High cement pressures that are required for good cement penetration are generated by creating a sealed volume in the femoral canal. Proximal femoral pressurisers coupled with distal cement restrictors create a sealed volume in the femoral canal for injection using a cement gun.…”

“…Studies of proximal cement pressurisers mainly focus on pressures generated (rather than pressures generated in each Gruen zone). [6][7][8] Two commonly used types of cement pressurisers are the Exeter MIS half-moon femoral cement seal (Stryker Orthopedics, Mahwah [NJ], USA) and the femoral canal pressuriser (Stryker Orthopedics, Mahwah [NJ], USA). The latter is designed to fit into the medullary canal of the proximal femur ( Fig.…”

Femoral Stem Cementation in Primary Total Hip Arthroplasty

“…Given the critical impact of cement pressurization on interdigitation, multiple in vitro studies assessed the impact of different pressurizer models on cement pressure and pressure duration. Wang et al compared a commercially available pressurizer with a modified system designed to better fit the proximal canal opening and noted a substantially higher pressure for a longer duration with the modified model 128 . While some studies focused on achieving the highest canal pressure, other authors prioritized achieving a longer duration of an acceptable pressure because of concern with bone cement implantation syndrome (BCIS), a rare but potentially fatal complication that can manifest as hypoxia, hypotension, and cardiovascular collapse 129 .…”