Shear Properties of Bilaminar Polymethylmethacrylate Cement Mantles in Revision Hip Joint Arthroplasty

Abstract

Although cement-within-cement revision arthroplasty minimizes the complications associated with removal of secure PMMA, failure at the interfacial region between new and old cement mantles remains a theoretical concern. This article assesses the variability in shear properties of bilaminar cement mantles related to duration of postcure and the use of antibiotic cements. Bilaminar cement mantles were 15% to 20% weaker than uniform mantles (P < .001) and demonstrated variability in shear strength related to duration of postcure of the freshly applied cement (P < .001). The use of Antibiotic Simplex did not significantly influence interfacial cement adhesion (P = .52). Interfacial adhesion by mechanisms other than mechanical interlock plays a significant role in the bond formed between new and old PMMA cements, with an important contribution by diffusion-based molecular interdigitation. In the presence of a secure cement-bone interface, we recommend cement-within-cement revision techniques in suitable patients.

Cement-in-cement stem revision for Vancouver type B periprosthetic femoral fractures after total hip arthroplasty

“…There has been ongoing debate over the use of the cement-in-cement technique for over 30 years, based on laboratory (Greenwald et al 1978, Rosenstein et al 1992, Li et al 1996, Weinrauch et al 2007) and clinical data (Lieberman et al 1993, Nelson 2002, Mandziak et al 2007, Goto et al 2008). Some reports support its use in revision hip arthroplasty, with no radiographic loosening in 42 cases at 30 months (Quinlan et al 2006) and no re-revisions for stem loosening in 191 cases at 5–16 year follow-up (Duncan et al 2009).…”

The effect of surface finish and interstitial fluid on the cement-in-cement interface in revision surgery of the hip

“…The cement was poured into the mould in its liquid phase at between 90 and 120 seconds after the start of mixing to allow for an optimal interfacial bond. 4,5,7,[13][14][15] Samples were removed from the moulds after curing for 24 hours in a dry environment at 23°C ± 1°C and then tested. 19 Investigated variants.…”

“…However, this technique is still used relatively rarely because of controversy regarding some of its aspects. 8,[11][12][13][14][15][16] Those practising cement-in-cement revision have recognised the importance of keeping the primary surface dry before the application of the secondary cement. This allows both a chemical bond to be made and the polymerisation of cement across the interface.…”

“…This allows both a chemical bond to be made and the polymerisation of cement across the interface. 2,[4][5][6][7][8]11,12,[14][15][16] Some authors have suggested that absolute dryness cannot be achieved. Li et al 13 explored a clinically rare situation when the primary mantle canal was flooded with high-viscosity bone marrow.…”

“…[4][5][6][7]11,13,15,17 Whenever reaming of the primary mantle canal is required to accommodate the secondary stem, roughening is unavoidable, but this may destroy the primary mantle or cement-bone interface leading to early loosening. There are no published data which quantify the effect of roughening on the strength of the cement-in-cement interface.…”