Surface Finish Mechanics Explain Different Clinical Survivorship of Cemented Femoral Stems for Total Hip Arthroplasty

Abstract

The ability of bone cement to adhere to the implant surface is dependent on the surface finish. Stems with a rough surface finish require greater force to disrupt their interface with the cement than do stems with a smooth or polished surface. However, if micromotion occurs at the cement-metal interface, the fretting of a smoother surface implant results in less cement and metallic abrasion than an implant with a rough surface finish. Today, surgeons implant femoral stems with a wide variety of surface finish and textures that are supported by the previously mentioned contrasting philosophy of fixation. This article presents the micro and macro surface finish mechanics, history, and rationale for changes in surface finish, the clinical and operative implications of changes in surface finish, the retrieval analysis, and the clinical evidence that examine the consequences of changes in surface finish in the outcome of cemented femoral stems for total hip arthroplasty. Current data and our own experience support the use of cemented femoral stems with a smooth or polished surface finish.

The Influence of Surface Roughness and Cementing Technique on the Microstructure and Mechanical Strength at the Cement-Prosthesis Interface

“…However, long-term follow-up studies on the cemented rough stems clearly revealed a significantly higher loosening and revision rate than that of polished stems. [4][5][6][7][8][9] This contradiction between biomechanical theory and clinical observation is yet to be resolved.…”

The modern, hybrid total hip arthroplasty for primary osteoarthritis at the Hospital for Special Surgery

“…19,20 In contrast, certain changes in cement fixation and the polymer itself were detrimental and were abandoned. [21][22][23] In recent years there has been a tendency towards an increased use of cementless femoral fixation. 24 The shift in the choice of fixation followed the consistent, durable fixation obtained with uncemented acetabular components, 12,25 ease of implantation, and the poor results of cemented fixation observed with rough and pre-coated stems.…”

“…24 The shift in the choice of fixation followed the consistent, durable fixation obtained with uncemented acetabular components, 12,25 ease of implantation, and the poor results of cemented fixation observed with rough and pre-coated stems. [21][22][23] Unlike cementless femoral fixation, cemented fixation has numerous advantages: it is versatile, durable and can be used regardless of the diagnosis, proximal femoral geometry, anteversion, and bone quality. It can also act as a local antibiotic delivery system.…”

Freisetzung des Röntgenkontrastmittels Zirkoniumdioxid an der implantatzugewandten Seite von PMMA-Zementköchern - REM-Analyse und -Charakterisierung bei zementierten Hüftendoprothesenschäften vom Typ CF-30

“…Als Hauptursache für eine Revisionsoperation (80 % der Revisionen) gibt das Finnish Arthoplasty Register die aseptische Lockerung an (OTTO et al 2006). Bei zementierten femoralen Komponenten beträgt der Anteil aseptisch bedingter Revisionen bis zu 25 % (BEKSAC et al 2006). Eine septische Genese findet sich hingegen nur bei etwa 1 % der Revisionen (LÖHR und KATZER 2005).…”

“…Sir John Charnley, in Kooperation mit Denis C. Smith, übertrug Ende der 1950er Jahre das aus der Dentalchirurgie bekannte Prinzip der Einzementierung von Implantaten auf die Gelenkendoprothetik und erreichte durch die Verwendung des PMMA-Knochenzementes wesentlich bessere Verweildauern (DI MAIO 2002, SMITH 2005. Schon 1958 erkannte Charnley die Probleme der Schwergängigkeit und des Abriebs von Endoprothesen und entwickelte später das Konzept der low friction arthroplasty (LFA), welches bis heute als Goldstandard gilt und gute Langzeitergebnisse erzielt (HERNANDEZ-VAQUERO et al 2008, GOETZ und HARRIS 1993, BEKSAC et al 2006. Mit der Einführung des HMWPE (High Molecular Weight Polyethylene) im Jahre 1962 gelang Charnley ein weiterer entscheidender Schritt zur Reduktion abriebbedingter Probleme (ELKE 2001).…”