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Chen W, Zhang H. An experimental study on the impact of prosthesis temperature on the biomechanical properties of bone cement fixation. BMC Surg 2023; 23:191. [PMID: 37407954 DOI: 10.1186/s12893-023-02079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/14/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To investigate the effect of the femoral component and tibial plateau component temperature on the strength of cement fixation during total knee arthroplasty (TKA). METHODS Femoral prosthesis, tibial plateau prosthesis, and polypropylene mold base were used to simulate TKA for bone cement fixation. Pre-cooling or pre-warming of femoral and tibial plateau components at different temperatures (4 °C, 15 °C, 25 °C, 37 °C, 45 °C), followed by mixing and stirring of bone cement at laboratory room temperature (22 °C), were performed during research. The prosthesis and the base adhered together, and the bone cement was solidified for 24 h at a constant temperature of 37 °C to verify the hardness of the bone cement with a push-out test. RESULTS The push-out force of the femoral prosthesis after fixation was higher than that of the tibial plateau prosthesis, and with the increase of the prosthesis temperature, the push-out force after fixation of the bone cement also increased linearly and the porosity of the prosthetic cement in the tibia and femur decreased as the temperature increased. CONCLUSION Without changing the mixing temperature and solidification temperature, the fixation strength of the femoral prosthesis is higher than that of the tibial plateau prosthesis. Properly increasing the temperature of the prosthesis can increase the push-out force of the fixation strength.
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Affiliation(s)
- Wanzhuo Chen
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, China
| | - Haining Zhang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266000, China.
- State Key Discipline: Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China.
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2
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Liu N, Zheng C, Wang Q, Huang Z. Treatment of non-traumatic avascular necrosis of the femoral head (Review). Exp Ther Med 2022; 23:321. [PMID: 35386618 PMCID: PMC8972838 DOI: 10.3892/etm.2022.11250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/26/2022] [Indexed: 11/06/2022] Open
Abstract
Non-traumatic osteonecrosis of the femoral head is the main cause of disability in young individuals and incurs major health care expenditure. The lifestyle changes in recent years, especially increased use of hormones and alcohol consumption, has greatly increased the incidence of femoral head necrosis. The underlying causes and risk factors of osteonecrosis of the femoral head are increasingly being elucidated, which has led to the development of novel surgical and non-surgical treatment options. Although the main goal of any treatment method is prevention and delaying the progression of disease, there is no common consensus on the most suitable method of treatment. The present review discussed the latest developments in the etiology and treatment methods for femoral head necrosis.
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Affiliation(s)
- Ning Liu
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | | | - Qinglong Wang
- Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Zhipeng Huang
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, Shaanxi 710000, P.R. China
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3
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Funk GA, Menuey EM, Ensminger WP, Kilway KV, McIff TE. Elution of rifampin and vancomycin from a weight-bearing silorane-based bone cement. Bone Joint Res 2021; 10:277-284. [PMID: 33845590 PMCID: PMC8077179 DOI: 10.1302/2046-3758.104.bjr-2020-0430.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS Poly(methyl methacrylate) (PMMA)-based bone cements are the industry standard in orthopaedics. PMMA cement has inherent disadvantages, which has led to the development and evaluation of a novel silorane-based biomaterial (SBB) for use as an orthopaedic cement. In this study we test both elution and mechanical properties of both PMMA and SBB, with and without antibiotic loading. METHODS For each cement (PMMA or SBB), three formulations were prepared (rifampin-added, vancomycin-added, and control) and made into pellets (6 mm × 12 mm) for testing. Antibiotic elution into phosphate-buffered saline was measured over 14 days. Compressive strength and modulus of all cement pellets were tested over 14 days. RESULTS The SBB cement was able to deliver rifampin over 14 days, while PMMA was unable to do so. SBB released more vancomycin overall than did PMMA. The mechanical properties of PMMA were significantly reduced upon rifampin incorporation, while there was no effect to the SBB cement. Vancomycin incorporation had no effect on the strength of either cement. CONCLUSION SBB was found to be superior in terms of rifampin and vancomycin elution. Additionally, the incorporation of these antibiotics into SBB did not reduce the strength of the resultant SBB cement composite whereas rifampin substantially attenuates the strength of PMMA. Thus, SBB emerges as a potential weight-bearing alternative to PMMA for the local delivery of antibiotics. Cite this article: Bone Joint Res 2021;10(4):277-284.
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Affiliation(s)
- Grahmm August Funk
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Elizabeth M Menuey
- Department of Chemistry, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - William P Ensminger
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kathleen V Kilway
- Department of Chemistry, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Terence E McIff
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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4
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Hoellwarth JS, Al Muderis M, Rozbruch SR. Cementing Osseointegration Implants Results in Loosening: Case Report and Review of Literature. Cureus 2020; 12:e7066. [PMID: 32226668 PMCID: PMC7089626 DOI: 10.7759/cureus.7066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022] Open
Abstract
Skeletal transcutaneous osseointegration was performed on a 54-year-old female transfemoral amputee. None of the available osseointegration implants achieved press-fit stability, so an implant was cemented in position. Although initially stable, by six months the patient reported painful loading and radiographs revealed cement mantle lucency. The osseointegration implant was removed, antibiotics were delivered via implanted spacer and intravenously, and revision osseointegration three months later achieved appropriate immediate press-fit stability. Cemented transcutaneous osseointegration implants loosen within one year. Osseointegration is only successful when bone grows directly onto the implant.
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Affiliation(s)
| | - Munjed Al Muderis
- Orthopaedic Surgery, Macquarie University Hospital, Macquarie Park, AUS
| | - S Robert Rozbruch
- Limb Salvage and Amputation Reconstruction Center, Hospital for Special Surgery, New York, USA
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5
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Farrier AJ, Moore L, Manning W, Avila C, Collins SN, Holland J. Comparison study of temperature and deformation changes in the femoral component of a novel ceramic-on-ceramic hip resurfacing bearing to a metal standard, using a cadaveric model. Proc Inst Mech Eng H 2019; 233:1318-1326. [PMID: 31608770 DOI: 10.1177/0954411919881520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hip resurfacing is an attractive alternative to total hip replacement preserving bone and reducing dislocation risk. Recent metal-on-metal designs have caused failure due to metal wear debris. Ceramic implants may mitigate this risk. Temperature increase in periprosthetic bone during cementation can lead to osteonecrosis, while deformation of the component can affect joint lubrication and may increase wear through clamping. Both processes may lead to implant loosening. This study quantifies the temperature and deformation change in a novel ceramic hip resurfacing femoral component compared to a metal standard during cemented implantation in a fresh frozen cadaveric model. Study design and methods Eight femora were prepared from four fresh frozen cadavers. One surgeon experienced in hip resurfacing surgery (J.H.) prepared the femora by reaming. Four ceramic and four metal implants of equal and varying size were cemented in place. Bone and surface temperatures were taken using a probe in the periprosthetic bone and an infrared laser thermometer, respectively. Deformation was measured using a micrometre. Measurements were taken before implantation and every 5-min intervals up to 30 min. The average bone-temperature increment was lower for ceramic heads than for metal heads. Although this difference was not statistically significant, the average bone temperature incremental change in small sizes (42 and 46 mm) was higher than in the large sizes (48 and 50 mm). Most metal heads sustained bearing diameter change that was still near its peak value 30 min after implantation, whereas the ceramic heads suffered a lower diameter change and most of the samples recovered their original diameter 30 min after implantation. Both implants behave similarly, however, a lower temperature rise in bone was observed with ceramic heads. This may lower the risk for thermal damage on periprosthetic bone. The ceramic heads deformed less during surgical implantation. This was not significant.
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Affiliation(s)
- Adam James Farrier
- Trauma and Orthopaedics, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lauren Moore
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Will Manning
- Orthopaedics, Freeman Hospital, Newcastle upon Tyne, UK
| | | | | | - James Holland
- Newcastle Surgical Training Centre, Freeman Hospital, Newcastle upon Tyne, UK
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Palmieri V, Papi M, Conti C, Ciasca G, Maulucci G, De Spirito M. The future development of bacteria fighting medical devices: the role of graphene oxide. Expert Rev Med Devices 2016; 13:1013-1019. [DOI: 10.1080/17434440.2016.1245612] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am 2015; 97:1604-27. [PMID: 26446969 DOI: 10.2106/jbjs.o.00071] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Although multiple theories have been proposed, no one pathophysiologic mechanism has been identified as the etiology for the development of osteonecrosis of the femoral head. However, the basic mechanism involves impaired circulation to a specific area that ultimately becomes necrotic.➤ A variety of nonoperative treatment regimens have been evaluated for the treatment of precollapse disease, with varying success. Prospective, multicenter, randomized trials are needed to evaluate the efficacy of these regimens in altering the natural history of the disease.➤ Joint-preserving procedures are indicated in the treatment of precollapse disease, with several studies showing successful outcomes at mid-term and long-term follow-up.➤ Studies of total joint arthroplasty, once femoral head collapse is present, have described excellent outcomes at greater than ten years of follow-up, which is a major advance and has led to a paradigm shift in treating these patients.➤ The results of hemiresurfacing and total resurfacing arthroplasty have been suboptimal, and these procedures have restricted indications in patients with osteonecrosis of the femoral head.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Jeffrey J Cherian
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont:
| | - Rafael J Sierra
- Mayo Clinic, 200 First Street S.W., Gonda 14 South, Rochester, MN 55905
| | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University, 601 North Caroline Street, JHOC 5245, Baltimore, MD 21287
| | - Jay R Lieberman
- Keck Medical Center of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033
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Bone temperature during cementation with a heatsink: a bovine model pilot study. BMC Res Notes 2014; 7:494. [PMID: 25099248 PMCID: PMC4126909 DOI: 10.1186/1756-0500-7-494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/20/2014] [Indexed: 11/18/2022] Open
Abstract
Background Bone cement is an effective means of supporting implants, but reaches high temperatures while undergoing polymerisation. Bone has been shown to be sensitive to thermal injury with osteonecrosis reported after one minute at 47°C. Necrosis during cementing may lead to loosening of the prosthesis. Some surgeons fill the joint cavity with cool irrigation fluid to provide a heatsink during cementing, but this has not been supported by research. This paper assesses a simple technique to investigate the efficacy of this method. Findings We used a model acetabulum in a bovine humerus to allow measurement of bone temperatures in cementing. Models were prepared with a 50 mm diameter acetabulum and three temperature probe holes; two as close as possible to the acetabular margin at half the depth of the acetabulum and at the full depth of the acetabulum, and one 10 mm from the acetabular rim. Four warmed models were cemented with Palacos RG using a standard mixing system and a 10 mm polyethylene disc to represent an acetabular component. Two of the acetabular models were filled with room temperature water to provide a heatsink. An electronic probe measured temperature at 5 second intervals from the moment of cementing. In the models with no heatsink, peak temperature was 40.3°C. The mean temperature rise was 10.9°C. In the models with a heatsink, there was an average fall in the bone temperature during cementing of 4.4°C. Conclusions These results suggest that using a heatsink while cementing prostheses may reduce the peak bone temperature. This study demonstrates a simple, repeatable technique which may be useful for larger trials.
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Janssen D, Srinivasan P, Scheerlinck T, Verdonschot N. Effect of cementing technique and cement type on thermal necrosis in hip resurfacing arthroplasty--a numerical study. J Orthop Res 2012; 30:364-70. [PMID: 21882236 DOI: 10.1002/jor.21512] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 07/08/2011] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Dennis Janssen
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
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10
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Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty. INTERNATIONAL ORTHOPAEDICS 2012; 36:1333-40. [PMID: 22234704 DOI: 10.1007/s00264-011-1464-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/06/2011] [Indexed: 12/12/2022]
Abstract
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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11
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Baker R, Whitehouse M, Kilshaw M, Pabbruwe M, Spencer R, Blom A, Bannister G. Maximum temperatures of 89°C recorded during the mechanical preparation of 35 femoral heads for resurfacing. Acta Orthop 2011; 82:669-73. [PMID: 22066558 PMCID: PMC3247883 DOI: 10.3109/17453674.2011.636681] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE We noticed that our instruments were often too hot to touch after preparing the femoral head for resurfacing, and questioned whether the heat generated could exceed temperatures known to cause osteonecrosis. PATIENTS AND METHODS Using an infra-red thermal imaging camera, we measured real-time femoral head temperatures during femoral head reaming in 35 patients undergoing resurfacing hip arthroplasty. 7 patients received an ASR, 8 received a Cormet, and 20 received a Birmingham resurfacing arthroplasty. RESULTS The maximum temperature recorded was 89°C. The temperature exceeded 47°C in 28 patients and 70°C in 11. The mean duration of most stages of head preparation was less than 1 min. The mean time exceeded 1 min only on peripheral head reaming of the ASR system. At temperatures lower than 47°C, only 2 femoral heads were exposed long enough to cause osteonecrosis. The highest mean maximum temperatures recorded were 54°C when the proximal femoral head was resected with an oscillating saw and 47°C during peripheral reaming with the crown drill. The modified new Birmingham resurfacing proximal femoral head reamer substantially reduced the maximum temperatures generated. Lavage reduced temperatures to a mean of 18°C. INTERPRETATION 11 patients were subjected to temperatures sufficient to cause osteonecrosis secondary to thermal insult, regardless of the duration of reaming. In 2 cases only, the length of reaming was long enough to induce damage at lower temperatures. Lavage and sharp instruments should reduce the risk of thermal insult during hip resurfacing.
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Affiliation(s)
- Richard Baker
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | | | - Michael Kilshaw
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | | | - Robert Spencer
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Ashley Blom
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
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Heidenreich D, Langhoff JD, Nuss K, Kluge K, Kämpf K, Zlinsky K, Hilbe M, Mayer J, von Rechenberg B. The use of BoneWelding® technology in spinal surgery: an experimental study in sheep. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1821-36. [PMID: 21523457 PMCID: PMC3207336 DOI: 10.1007/s00586-011-1799-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/22/2011] [Accepted: 04/08/2011] [Indexed: 11/26/2022]
Abstract
The innovative BoneWelding(®) technology, where ultrasound energy bonds bioresorbable implants to bone, was tested for its feasibility in spine surgery and its local thermal effects. The three tested concepts consisted of implementation of a resorbable plating system, two converging polymer pins and suture anchors to the cervical vertebral bodies. Bioresorbable polylactide implants (PLDLLA 70/30) were inserted ventrally into the third and fourth vertebral body of seven sheep, of which six were sacrificed at 2 months and one sheep immediately after temperature measurements during implant insertion. Polymer screws were used as controls. Qualitative, semi-quantitative histological, and quantitative histomorphometrical evaluation showed excellent anchorage of the implants, new mineralized bone at the implant-bone interface, no inflammatory cell reaction or thermal damage to the adjacent bone in response to the novel insertion technology. The application of two converging pins, parallel inserted polymer pins, or fusion of the implant to the polymer plates did not affect the overall excellent tissue tolerance of the technology. Temperature increase during insertion was noticed but never exceeded 47°C for less than 1 s. The BoneWelding(®) technology was proven to be safe and easy to apply.
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Affiliation(s)
- Dorothee Heidenreich
- Musculoskeletal Research Unit, Equine Department, Vetsuisse Faculty ZH, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | | | - Katja Nuss
- Musculoskeletal Research Unit, Equine Department, Vetsuisse Faculty ZH, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Katharina Kluge
- Veterinary Anesthesiology, Equine Department, Vetsuisse Faculty ZH, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Käthi Kämpf
- Musculoskeletal Research Unit, Equine Department, Vetsuisse Faculty ZH, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Katalin Zlinsky
- Musculoskeletal Research Unit, Equine Department, Vetsuisse Faculty ZH, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Monika Hilbe
- Veterinary Pathology, Vetsuisse Faculty ZH, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
| | - Jörg Mayer
- SpineWelding AG, Wagistr. 6, 8952 Schlieren, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, Equine Department, Vetsuisse Faculty ZH, University of Zurich, Winterthurerstr. 260, 8057 Zurich, Switzerland
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Abstract
Polymethylmethacrylate (PMMA) has been used in orthopaedics since the 1940s. Despite the development and popularity of new biomaterials, PMMA remains popular. Although its basic components remain the same, small proprietary and environmental changes create variations in its properties. PMMA can serve as a spacer and as a delivery vehicle for antibiotics, and it can be placed to eliminate dead space. Endogenous and exogenous variables that affect its performance include component variables, air, temperature, and handling and mixing. PMMA is used in hip arthroplasty and vertebral augmentation, notably, vertebroplasty and kyphoplasty. Cardiopulmonary complications have been reported.
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14
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Shimmin AJ, Walter WL, Esposito C. The influence of the size of the component on the outcome of resurfacing arthroplasty of the hip. ACTA ACUST UNITED AC 2010; 92:469-76. [DOI: 10.1302/0301-620x.92b4.22967] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The survivorship of contemporary resurfacing arthroplasty of the hip using metal-on-metal bearings is better than that of first generation designs, but short-term failures still occur. The most common reasons for failure are fracture of the femoral neck, loosening of the component, osteonecrosis of the femoral head, reaction to metal debris and malpositioning of the component. In 2008 the Australian National Joint Registry reported an inverse relationship between the size of the head component and the risk of revision in resurfacing hip arthroplasty. Hips with a femoral component size of ≤ 44 mm have a fivefold increased risk of revision than those with femoral components of ≥ 55 mm irrespective of gender. We have reviewed the literature to explore this observation and to identify possible reasons including the design of the implant, loading of the femoral neck, the orientation of the component, the production of wear debris and the effects of metal ions, penetration of cement and vascularity of the femoral head. Our conclusion is that although multifactorial, the most important contributors to failure in resurfacing arthroplasty of the hip are likely to be the design and geometry of the component and the orientation of the acetabular component.
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Affiliation(s)
- A. J. Shimmin
- Melbourne Orthopaedic Group Research Foundation, 33 The Avenue, Windsor, 3181 Victoria, Australia
| | - W. L. Walter
- Specialist Orthopaedic Group Mater Clinic, Suite 1.08, 3-9 Gillies Street, North Sydney, New South Wales 2060, Australia
| | - C. Esposito
- Specialist Orthopaedic Group Mater Clinic, Suite 1.08, 3-9 Gillies Street, North Sydney, New South Wales 2060, Australia
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15
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Raiss P, Pape G, Jäger S, Loew M, Bitsch R, Rickert M. In vitro measurement of temperature changes during implantation of cemented glenoid components. Acta Orthop 2010; 81:211-5. [PMID: 20367412 PMCID: PMC2895340 DOI: 10.3109/17453671003717823] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE It is unclear whether the increase in temperature during cement curing may cause osteonecrosis, leading to loosening of the glenoid component in shoulder arthroplasty. We therefore analyzed the temperature during implantation of cemented glenoid implants. METHODS 8 keeled and 8 pegged glenoids were implanted in standardized fashion in 8 pairs of scapulas. Temperature and pressure sensors were implanted at the bone-cement interface in the glenoid. Real-time measurements were made of temperature and pressure within the glenoid vault. RESULTS In no case was the temperature reached high enough to endanger the surrounding bone. The mean increase in temperature was 5 degrees (0.5-6.9) in the keeled group and 2.7 degrees (1.7-3.6) in the pegged group. The mean maximum pressure in the keeled group was 50 kPa (20-100) and in the pegged group it was 113 kPa (60- 181). Both differences were statistically significant. INTERPRETATION The temperatures that occur during implantation of cemented components are low and probably not high enough to cause osteonecrosis in the surrounding bone.
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Affiliation(s)
- Patric Raiss
- Department of Orthopaedics, University of HeidelbergGermany
| | - Guido Pape
- Department of Orthopaedics, University of HeidelbergGermany
| | | | - Markus Loew
- Department of Orthopaedics, University of HeidelbergGermany
| | - Rudi Bitsch
- Department of Orthopaedics, University of HeidelbergGermany
| | - Markus Rickert
- Department of Orthopaedics, University of HeidelbergGermany
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16
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Letter to the editor: Association of osteonecrosis and failure of hip resurfacing arthroplasty. Clin Orthop Relat Res 2010; 468:902-3; author reply 904-5. [PMID: 20012718 PMCID: PMC2816786 DOI: 10.1007/s11999-009-1194-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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17
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Zustin J, Sauter G, Morlock MM, Rüther W, Amling M. Association of osteonecrosis and failure of hip resurfacing arthroplasty. Clin Orthop Relat Res 2010; 468:756-61. [PMID: 19597896 PMCID: PMC2816773 DOI: 10.1007/s11999-009-0979-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 06/26/2009] [Indexed: 01/31/2023]
Abstract
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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Affiliation(s)
- Jozef Zustin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246 Hamburg, Germany
| | - M. Michael Morlock
- Biomechanics Section, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Wolfgang Rüther
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- Center for Biomechanics and Skeletal Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Scheerlinck T, Delport H, Kiewitt T. Influence of the cementing technique on the cement mantle in hip resurfacing: an in vitro computed tomography scan-based analysis. J Bone Joint Surg Am 2010; 92:375-87. [PMID: 20124065 DOI: 10.2106/jbjs.i.00322] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The cement mantle within a hip resurfacing head is important for implant survival. Too much cement leads to thermal bone necrosis, whereas not enough cement might cause mechanical failure and particle-induced osteolysis. We evaluated the impact of different cementing techniques on the quality of the cement mantle in hip resurfacing. METHODS Sixty bovine condyles were prepared to fit a size-46 ReCap (Biomet) implant and divided into five groups of twelve specimens each. In two of the groups, a polymeric replica was filled halfway with low-viscosity cement; suction was employed in one of those groups and not used in the other. Medium-viscosity cement was used in the remaining three groups: it was spread out within the implant in one group, it was packed on the bone in another, and a combination of those techniques was used in the third. Half of the sixty specimens had six anchoring holes. The specimens underwent computed tomography and were analyzed with custom-made segmentation software. RESULTS The cementing technique and anchoring holes influenced the cement quantity within the implant and the thickness of the cement mantle; suction and bone density did not. Both filling techniques involving the use of low-viscosity cement resulted in excessive cement within the implant (filling index, 47.30% to 60.66%) and large cement defects at the base. The combined technique also resulted in large cement quantities (filling index, 46.62% to 54.12%) but fewer cement defects at the base. The filling technique involving the use of medium-viscosity cement decreased the cement quantity (filling index, 43.31% to 45.68%), but cement packing was the best technique (filling index, 29.20% to 31.05%), resulting in the thinnest, most homogeneous cement mantle. However, distal cement defects remained, and the prevalence of proximal cement-implant interfacial gaps was about 10%. CONCLUSIONS The results of this experimental study cannot be extrapolated directly to the in vivo situation, and they apply only to implants with an inner geometry similar to that of the size-46 ReCap resurfacing head and to the cement brands that we used. None of the cementing techniques was "perfect." Both of the filling techniques involving use of low-viscosity cement and the combined technique resulted in excessive cement proximally. The filling technique involving use of medium-viscosity cement was promising, but the cement-packing technique offered the best opportunity to control the quality of the cement mantle. However, the presence of interfacial gaps raised new questions. We suggest that the use of anchoring holes in cancellous bone should be considered with caution in order to avoid overfilling with cement.
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Affiliation(s)
- Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel,1090 Brussels, Belgium.
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