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Reulbach M, Evers P, Emonde C, Behnsen H, Nürnberger F, Windhagen H, Jakubowitz E. Implications of ageing effects on thermal and mechanical properties of PMMA-based bone cement for THA revision surgery. J Mech Behav Biomed Mater 2023; 148:106218. [PMID: 37931550 DOI: 10.1016/j.jmbbm.2023.106218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
Loosening and infection are the main reasons for revision surgery in total hip arthroplasty (THA). Removing partially detached cemented implant components during revision surgery remains challenging and poses the risk of periprosthetic bone damage. A promising approach for a gentler removal of partially detached prostheses involves softening the PMMA-based bone cement by heating it above its glass transition temperature (TG), thus loosening the implant-cement bond. It is assumed that the TG of PMMA-based bone cement decreases in-vivo due to the gradual absorption of body fluid. Reliable data on TG are essential to develop a heat-based method for removing cemented implant components during revision surgery. The effect of water absorption was investigated in-vitro by ageing PMMA-based bone cement samples for different periods up to 56 days in both Ringer's solution (37 °C) and air (37 °C and 30% humidity). Subsequently, the TG and Vicat softening temperatures of the samples were determined by differential scanning calorimetry and Vicat tests, respectively, according to prescribed methods. Over the entire ageing period, i.e. comparing one day of ageing in air and 56 days in Ringer's solution, the Vicat softening temperature dropped by 16 °C, while the TG dropped by 10 °C for Palacos® R PMMA-based bone cement. Water absorption over time correlated significantly with the Vicat softening temperature until saturation of the PMMA-based bone cement was reached. Based on the TG and Vicat softening temperature measurements, it can be assumed that in body-aged bone cement, an optimal softening can be achieved within a temperature range of 85 °C-93 °C to loosen the bond between the PMMA-based bone cement mantle and the prosthesis stem. These findings may pave the way for a gentler removal of the implant in revision THA.
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Affiliation(s)
- Magnus Reulbach
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hannover, Germany
| | - Patrick Evers
- Institute of Materials Science (Werkstoffkunde), Leibniz University Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - Crystal Emonde
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hannover, Germany
| | - Hannah Behnsen
- Institute of Plastics and Circular Economy, Leibniz University Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - Florian Nürnberger
- Institute of Materials Science (Werkstoffkunde), Leibniz University Hannover, An der Universität 2, 30823, Garbsen, Germany
| | - Henning Windhagen
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hannover, Germany
| | - Eike Jakubowitz
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hannover, Germany.
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O'Dowd-Booth CJ, White J, Smitham P, Khan W, Marsh DR. Bone cement: perioperative issues, orthopaedic applications and future developments. J Perioper Pract 2011; 21:304-308. [PMID: 22474774 DOI: 10.1177/175045891102100902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Bone cement has been increasingly used in orthopaedic surgery over the last 50 years. Since Sir John Charnley pioneered the use of polymethylmethacrylate cement in total hip replacements, there have been developments in cementing techniques and an expansion in the number of orthopaedic procedures that use cement. This review covers the perioperative issues surrounding bone cement including storage, cementing techniques and complications. It also discusses specific orthopaedic applications of bone cement and future developments.
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Affiliation(s)
- Christopher John O'Dowd-Booth
- UCL Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP
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