The Femoral Stem/Cement Interface in Total Hip Replacement

Vl, Fornasier; Hu, Cameron

doi:10.1097/00003086-197605000-00041

Cited by 30 publications

(24 citation statements)

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“…Cementing techniques [16], surface roughness patches [17], textures [18], and pre-coatings [7,[19][20][21] have been considered to create a reliable and endurable fixation. However, as long as the bond between the stem and the cement mantle cannot be secured for the complete lifetime of the implant, not just the bonding strength, but also the fail-safe mechanism against the effects of debonding should be considered.…”

Section: Discussionmentioning

confidence: 99%

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Surface roughness of debonded straight-tapered stems in cemented THA reduces subsidence but not cement damage

Verdonschot

Huiskes

1998

Biomaterials

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Although stress analyses have shown that the mechanical endurance of cemented femoral THA reconstructions is served by stems that firmly bond to their cement mantles, retrieval studies suggest that this may be difficult to achieve. Clinical studies with roentgen stereophotogrammetric analyses have shown that stems may gradually debond from their cement mantle. Accepting the fact that stem debonding is unavoidable, stem subsidence and cement stresses can be reduced by increasing stem-cement friction, as indicated by finite element stress analyses. Hence, it can be hypothesized that debonded stems with high surface roughness values would damage the cement mantle to a lesser extent as compared to polished ones. To confirm this hypothesis, tapered stems with polished and rough surface finishes were implanted in cement mantles and cyclically loaded for 1.7 million times. It was investigated how surface roughness affected the damage in the cement mantle, and how it was related to prosthetic subsidence.The polished taper subsided considerably more than the rough one (630 vs. 270 m at the end of the experiments). In addition, it was found that the polished taper displayed step-wise subsidence, which is probably due to the interaction of stick-slip processes at the interface, associated with creep of the acrylic cement. The rough taper subsided monotonously. Scanning Electron Microscopic (SEM) analysis of the taper-cement structures showed that the rough taper was completely debonded from the cement mantle, creating a gap at the interface, and that many large cement cracks and particles were created. Around the polished taper, only a few cracks were found and the taper-cement interface seemed undamaged.It was concluded that an increased surface roughness does not necessarily lead to a reduction in cement damage. On the contrary, compared to polished ones, debonded rough stems may produce more cement cracks and acrylic cement debris, and provide routes to transport these wear products. Hence, after failure of the stem-cement interface, straight-tapered stems with an increased surface roughness accelerate the failure process due to inferior fail-safe features. Consequently, in vivo subsidence patterns at the stem-cement interface should be considered in combination with the surface finish of the implant. An amount of post-operative subsidence of a rough stem may be much more damaging for the reconstruction than the same amount for a polished stem.

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Section: Discussionmentioning

confidence: 99%

“…One way to avoid these stress elevations is to prevent stem debonding. However, whether a permanent stem-cement bond can be obtained remains questionable, and debonding seems a rule rather than an exception [7][8][9]. The alternative to this concept is to accept that stem-cement debonding does occur, and minimize its effect.…”

Section: Introductionmentioning

confidence: 99%

Surface roughness of debonded straight-tapered stems in cemented THA reduces subsidence but not cement damage

Verdonschot

Huiskes

1998

Biomaterials

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“…A large assortment of variables are known to affect construct, especially at the prosthesis-cement interface the value of a specified property, the most influential (which has often been implicated in the loosening of the ones being formulation and porosity. Thus, great care prosthesis 121 ). To facilitate parametric studies of this distrimust be taken when conducting interformulation combution, the finite element analysis method and a 3-dimenparison.…”

mentioning

confidence: 99%

Properties of acrylic bone cement: State of the art review

Lewis¹

1997

J. Biomed. Mater. Res.

668

465

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Acrylic bone cement occupies a distinctive place in the hierarchy of synthetic biomaterials, because it is the only material currently used for anchoring the prosthesis to the contiguous bone in a cemented arthroplasty. However, the cement is not without its drawbacks. The main one is the role that it has been postulated to play in the aseptic loosening and, hence, clinical life of the arthroplasty. In turn, this role is directly related to the mechanical properties of the cement, especially the resistance to fracture of the cement in the mantle at the cement-prosthesis interface or the cement-bone interface. The present work is a detailed critical review of the recent literature on the properties of bone cement that are considered germane to its use in the stated application. The relevant properties are identified and a case is made for including each of them. Compilations of the values of these properties, obtained under clearly identified conditions, are presented for the six commercial formulations of bone cement in current popular orthopedic use. The gaps and unresolved questions in the current data base, efforts that should be made to address these issues, and research directions are covered.

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“…Fornasier and Cameron (1976) observed diffusion of tissue fluid between the prosthesis and the cement in well-fixed THR retrievals. Similarly, Schmalzried et al (1992) also found that joint fluid penetrated extensively along the boneimplant interface.…”

Section: Introductionmentioning

confidence: 95%