Thermal Effects of Cement Mantle Thickness for Hip Resurfacing

Little, J. Paige; Gray, Hans; Murray, D.W.; Beard, David; Gill, H. S.

doi:10.1016/j.arth.2007.02.015

Cited by 46 publications

(37 citation statements)

References 7 publications

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“…In agreement with Campbell et al, who considered values over five millimetres to be excessive [13], large cement masses have been demonstrated to reach temperatures of up to 68°C [26]. This could result in thermally induced ON [19,27] or reduced osseointegration [28]. Even though large masses of cement were observed in our specimens, the characteristic features of direct thermal injury to the viable bone, or ON, were not identifiable.…”

Section: Discussionsupporting

confidence: 50%

“…Several experimental studies recommend cement penetration into the bone of about 3-5 mm [15,16] to achieve optimal fixation and prevent harmful polymerisation temperatures [17], to achieve successful long-term fixation. Several studies [11,18,19] emphasise the importance of proper cementation. However, investigations into the clinical realisation of the recommended cementation technique for HRA, including quantitative cement data, are rare [13].…”

Section: Introductionmentioning

confidence: 99%

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Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty

Krause

Breer

Hahn

et al. 2012

International Orthopaedics (SICOT)

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Purpose The use of inappropriate cementation techniques has been suggested as an adverse factor for the long-term survival of hip-resurfacing arthroplasty. Inadequate initial fixation, thermal osteonecrosis and interface biological reactions are possible causes of failure. We analysed morphological changes associated with the cementation technique in a large collection of retrieved femoral components. Methods One hundred and fifty femoral components (mean time to failure of 8.3 months±11.0) obtained at revision surgery were analysed morphometrically and histopathologically. Cement mantle and penetration were quantified in six different regions of interest. Histopathological analysis of the bone-cement interface was performed on undecalcified processed bone tissue. Results The vast majority of the cases differed substantially from laboratory-based cement-penetration depth recommendations. Fifty-nine cases had a fibrous membrane at the cement-bone interface. This membrane was significantly thicker in cases with osteonecrosis compared to cases viable bone. Conclusions Our results demonstrate that most failures were cemented inappropriately. We suggest that poor cementation was an important adverse factor; however, the cause of the failures was obviously multifactorial. The thickness of the fibrous membrane at the cement-bone interface differed significantly between cases with osteonecrosis and specimens with viable bone tissue.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty

Krause

Breer

Hahn

et al. 2012

International Orthopaedics (SICOT)

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“…Retrieval analyses of femoral remnants of failed hip resurfacing arthroplasties attributable to either fracture [3,5,9,12,16,17] or loosening [3] suggest the presence of ON. ON reportedly occurs predominantly in early-and midterm hip failures and may relate to impaired blood supply to the femoral head [2,15,18] or heat injury [7,8] at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, ON was described mostly in failures attributable to fractures [14,16,17] and was suggested as a cause of the fracture [3,5,16]. Several causes of ON, particularly those related to surgical techniques, such as the effects of cementation [1,[7][8][9] or intraoperative extraosseous vascular injury [2,4,15,18,21], have been discussed.…”

Section: Introductionmentioning

confidence: 99%

Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty

Zustin

Sauter

Morlock

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Osteonecrosis (ON) has been reported in femoral remnants removed after failure of hip resurfacing arthroplasty. Experimental and clinical studies have further described thermal effects of the cementation technique, damage of extraosseous blood vessels, and intraoperative hypoxemia as possible causative factors. We analyzed histologically a series of 123 retrieved specimens with a preoperative diagnosis other than ON to investigate the incidence and extent of advanced ON. ON was found in 88% of cases and associated with 60% (51 of a total of 85) of periprosthetic fractures. The fracture incidence correlated with the extent of ON. Collapse of necrotic tissue in three (2%) cases resulted in disconnection of the bone stock-femoral component. We observed smaller regions of superficial ON in the majority of the remaining femoral remnants with periprosthetic fractures and in hips that failed for reasons other than fracture.

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“…Little et al 28 studied the temperature rise in surface replacements with a relatively thin mantle (0.5-1.5 mm). They found maximum temperatures ranging from 26.6 to 56.58C, depending on cement thickness, which does not differ much from our peak temperatures in the thin mantle models (31.9-45.18C).…”

Section: Discussionmentioning

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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Thermal Effects of Cement Mantle Thickness for Hip Resurfacing

Cited by 46 publications

References 7 publications

Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty

Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty

Association of Osteonecrosis and Failure of Hip Resurfacing Arthroplasty

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

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