Some Fundamental Aspects of Human Joint Replacement: Analyses of Stresses and Heat Conduction in Bone-Prosthesis Structures

Huiskes, R.

doi:10.3109/ort.1980.51.suppl-185.01

Cited by 92 publications

(90 citation statements)

References 110 publications

(80 reference statements)

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“…23 Large cement masses or thick cement layers would likely lead to thermal of bone. 25 The surface temperature of polymerizing cement depends on the thickness of the cement mass; peak polymerizing temperatures increase form 418C for a 1-mm thick cement layer to 568C for 5-mm and 608C for a 6-7-mm thick layer. 26 In general, a 2-5-mm deep cement penetration is believed to be optimal.…”

Section: Discussionmentioning

confidence: 99%

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Femoral cementing technique for hip resurfacing arthroplasty

Bitsch

Heisel

Silva

et al. 2007

Journal Orthopaedic Research

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The resurgence of metal-metal bearings has renewed interest in hip resurfacing, but a paucity of information exists regarding femoral cementing technique. We developed a laboratory model in which 72 open-cell foam specimens were used to simulate bone. Analyses of two cement viscosities, two foam porosities, and six cementing techniques were performed: manual cement application only, manual application and filling of one quarter of the component with cement, filling of half of the component, manual application and half component filling, full component filling, and manual application and full component filling. For manual application, cement was pressurized into the foam by rolling the finger tips. For component filling, a defined quantity of cement was poured into the component before pressing it onto the foam. Specimens were cut into quarters, and cement penetration was quantified in seven areas: top, chamfer, wall, interior area, and proximal, medial, and distal stem. The manual technique showed a 3-mm thick, even cement penetration of the outer fixation surface (top ¼ 26 AE 0 mm 2 , chamfer ¼ 14.9 AE 0.2 mm 2 , wall ¼ 55.6 AE 5.2 mm 2 ). None of the other techniques showed a significantly higher penetration in these areas. Large differences were found between all techniques at the medial stem (27.7 AE 17.5 mm 2 , p < 0.001) and the interior area (128.5 AE 69.6 mm 2 , p ¼ 0.013). An increasing degree of penetration occurred from manual cement application to manual application and full component filling. Sixteen specimens showed incomplete seating, which occurred with all techniques except the manual technique. The manual technique consistently gave an approximately 3-mm thick even cement penetration over the outer fixation area. Pouring any cement into the shell resulted in variable degrees of deeper penetration and a risk of incomplete seating, which have been associated with bone necrosis and early fracture.

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Section: Discussionmentioning

confidence: 99%

“…16,23,24 Cement layers with penetration depths over 5 mm would likely lead to thermal necrosis of bone. 25,26 Assuming that the same principles established for anchorage of knee replacements and acetabular cups also apply to femoral resurfacings seems reasonable, but a paucity of information exists in the literature.…”

Section: Introductionmentioning

confidence: 99%

Femoral cementing technique for hip resurfacing arthroplasty

Bitsch

Heisel

Silva

et al. 2007

Journal Orthopaedic Research

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“…Although the follow up is for only 2 years, the importance of short term follow up has been emphasised [9,24,34]. No differences were found between the three approaches as far as clinical improvement is concerned [23,35,39,44].…”

Section: Discussionmentioning

confidence: 99%

A comparison of three lateral approaches in primary total hip replacement

Pai¹

1998

International Orthopaedics

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Summary. Three different lateral approaches for a Charnley total hip replacement were studied in 264 operations. The transtrochanteric approach was used in 94, the Liverpool in 88 and the Hardinge in 82. The mean follow up was 2.6 years (range 2 to 3 years). The clinical result was the same in each group. Radiographs showed that alignment of the femoral stem was significantly better in the transtrochanteric group. Grade III socket demarcation was more frequent with the Liverpool approach. There was no difference in cement distribution between the 3 groups, except the acetabular cement distribution was poor with the Hardinge approach. There was no increase in Trendelenburg gait after the Hardinge or Liverpool approach compared with the transtrochanteric approach. Dislocation was a problem after the transtrochanteric approach and risk factors were retroversion of the acetabular cup and detachment of the trochanter. Severe heterotopic bone formation was 5 times more common after the Liverpool, compared with the other two, approaches.

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“…The specific heat of bone cement was assumed to be linearly dependent on its temperature. 20 Analysis of the CT data of the test specimens indicated that the interdigitated region of cement and bone consisted of 84% cement. Hence, we assigned only cement properties to this region.…”

Section: Methodsmentioning

confidence: 99%

“…An ideal interface conductivity was assumed at the implant-cement, cement-bone, and implant-bone interfaces, while at the implant-air and bone-air interface were assumed to have a conductivity of 7.0 and 3.0 W/m 2 K, respectively. 20 To replicate the experimental situation, the bone-air condition was also assumed at the distal end of the models.…”

Section: Methodsmentioning

confidence: 99%

Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty—a numerical study

Janssen

Scheerlinck

2011

Journal Orthopaedic Research

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Femoral fractures within resurfacing implants have been associated with bone necrosis, possibly resulting from heat generated by cement polymerization. The amount of heat generated depends on cement mantle volume and type of cement. Using finite element analysis, the effect of cement type and volume on thermal necrosis was analyzed. Based on CT-data of earlier implantations, two different models were created: a thick mantle model, representing a low-viscosity ''cement filling'' technique, and a thin mantle model, representing a high viscosity ''cement packing'' technique. Six cement types were analyzed. The polymerization heat generation and its effect on bone necrosis were predicted. In the thin cement mantle models, no thermal necrosis was predicted. Thick cement mantle models produced thermal necrosis at the cement-bone interface depending on cement type. In the worst case, 6% of the bone at the cement-bone interface became necrotic, covering almost the entire cross-sectional area. The current findings suggest a potential thermal drawback of thick cement mantles, although it is unclear whether thermal bone necrosis significantly affects implant fixation or increases the fracture risk. Furthermore, our study showed distinct differences between the heat generated and resulting thermal damage caused by the various cement types. Keywords: finite element analysis; bone cement; thermal necrosis; hip resurfacing arthroplasty Hip resurfacing arthroplasty is an alternative for total hip arthroplasty (THA), with the proposed benefits of bone stock preservation and increased stability. The most common causes for revision of resurfacing arthroplasty are fracture, loosening, and lysis. 1 Although most fractures occur at the implant rim, 20% occur within the femoral component. 2 These fractures have been associated with bone necrosis, 3 often occurring in the bone-cement interface region. It has been hypothesized that this necrotic layer is caused by heat generated by polymerizing bone cement, inducing thermal damage to the bone. 4 Since polymerization of bone cement is an exothermic reaction, the amount of heat generated is proportional to its volume. As a result, hip resurfacings with larger amounts of cement in the femoral head display more fibrous tissue at the cement-bone interface. 5,6 The size and shape of the cement mantle depends on the cementing technique and the type of cement. [7][8][9] The use of low viscosity cement poured into the femoral component 10 leads to a relatively deep cement penetration into the femoral head, 7-9 and a large total cement volume especially when anchoring holes are used. 8 In contrast, when high viscosity cement is manually applied to the femoral head, a more homogeneous, thinner cement mantle is obtained. 8,11 Another factor affecting the temperature rise is the polymerization properties of the cement. 12,13 A fast polymerizing cement will cause a higher peak temperature that will last for a short time, while slower polymerizing cement will cause a lower peak temperature t...

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Some Fundamental Aspects of Human Joint Replacement: Analyses of Stresses and Heat Conduction in Bone-Prosthesis Structures

Cited by 92 publications

References 110 publications

Femoral cementing technique for hip resurfacing arthroplasty

Femoral cementing technique for hip resurfacing arthroplasty

A comparison of three lateral approaches in primary total hip replacement

Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty—a numerical study

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