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Di Maria F, Das S, Abermann E, Hoser C, Fink C. Pulsed lavage is associated with better quality of bone-cement-implant interface in knee arthroplasties (TKA/UKA) compared to syringe lavage in vitro; however, clinical data are missing: A systematic review. J Exp Orthop 2024; 11:e12027. [PMID: 38774578 PMCID: PMC11106550 DOI: 10.1002/jeo2.12027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/08/2024] [Accepted: 03/15/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose The purpose of this systematic review is to analyse the available literature to ascertain the optimal method of bone preparation to improve the quality of bone-cement-implant interface with either pulsed lavage or syringe lavage in both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Methods A comprehensive search was conducted across MEDLINE, Scopus and Embase databases until July 2023. Both inclusion and exclusion criteria were clearly stated and used to identify all the published studies. Subsequent screening throughout the title, abstract and full text was made, followed by complete critical appraisal and data extraction. This sequential process was performed by two reviewers independently and summarised following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines). A quality assessment of the systematic review was performed according to the Quality Appraisal for Cadaveric Studies scale (QUACS), reaching a quality level ranging from 69% to 85%. Results A total of 10 articles, out of 47, nine biomechanical cadaveric studies and one human clinical study were analysed. A total of 196 UKA tibial components, 74 patellar components, 36 TKA tibial components and 24 UKA femoral components were retrieved, and a high level of heterogeneity resulted overall. The pulsed lavage group showed better cement penetration and higher pull-out force than the syringe lavage group; a higher interface temperature was also found in the pulsed lavage group. No differences were found regarding tension ligament forces between the groups. Conclusion Our systematic review suggests that pulsed lavage is superior to syringe lavage in terms of the quality of bone-cement-implant interface in knee arthroplasties (TKA/UKA). However, translation of these results from cadaveric studies to individual clinical settings may be hazardous; therefore, clinical in vivo prospective studies are highly needed. PROSPERO CRD PROSPERO CRD number CRD42023432399. Level of Evidence Level III.
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Affiliation(s)
- Fabrizio Di Maria
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
| | - Saubhik Das
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
| | - Elisabeth Abermann
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
| | - Christian Hoser
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
| | - Christian Fink
- Gelenkpunkt‐Sports‐and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and TechnologyPrivate University for Health SciencesHallAustria
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Hawellek T, von Lewinski G, Lehmann W, Kühn KD. [Cement in revision arthroplasty-what about the "glacier effect"? : Case studies viewed from different perspectives]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:185-194. [PMID: 37861705 DOI: 10.1007/s00132-023-04452-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The number of operations concerning revision arthroplasty has been increasing continuously in recent years, and it can be assumed that they will continue to increase in the future. If an arthroplasty implant becomes loose, it must be changed. The question often arises as to how the new implant should be fixed in the bone. ADVANTAGES Revision implants can be inserted into the bone without cement. In the subsequent period, a secondary osseointegration of the implant takes place. Another possibility is to anchor the implant by using bone cement. The advantage of cemented anchorage is that the implant is firmly fixed in the bone, in principle, immediately, and it is possible to fully load the implant directly. Direct postoperative full weight bearing is helpful, especially for older and multimorbid patients, in order to achieve rapid mobilization. PREREQUISITES AND CHALLENGES When using cement in revision cases, however, there are a few prerequisites and challenges that the surgeon should definitely take into account. In the case of revision, the bone in the former implant bed is often deficient and appears thinned and sclerosed. It is, therefore, important to analyze the bone quality preoperatively on radiographic images and to include it in the planning of the anchoring strategy. In addition, the individual bone quality of the patient must also be taken into account intraoperatively. In any case, it must be clarified whether the basic prerequisites for the sufficient bond strength of the cement with the bone to be formed can still be met. Furthermore, the principles of cementing technique must be strictly observed, and the goal of a perfect cement mantle must be aimed for. If the indication for this is overstated, early loosening of the cemented revision arthroplasty is very likely.
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Affiliation(s)
- Thelonius Hawellek
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Gabriela von Lewinski
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Klaus-Dieter Kühn
- Universitätsklinik für Orthopädie und Orthopädische Chirurgie, Medizinische Universität Graz, Graz, Österreich
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Labott JR, Heidenreich MJ, Broida SE, Mills GL, Rose PS, Houdek MT. Durability of intercalary endoprosthesis for humeral reconstruction. J Surg Oncol 2024; 129:410-415. [PMID: 37750341 DOI: 10.1002/jso.27458] [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: 07/07/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The humerus is a common site of metastases and primary tumors. For some patients with a segmental defect and/or diaphyseal cortical destruction a cemented intercalary device may provide a more reliable construct, however data on their use is limited. METHODS We reviewed 43 (28 male and 15 female) patients treated with an intercalary humeral spacer at a single tertiary referral center between 1989 and 2022. Humeral lesions were most commonly secondary to metastatic disease (n = 29, 68%), with 25 (58%) patients presenting with a pathologic fracture. Mean age and body mass index were 66 years and 27.9 kg/m2 . First generation taper joint device were used in 22 patients and second-generation lap device in 21 patients. RESULTS Following reconstruction the 2-year overall survival was 30%. Mechanical complications occurred in 11 patients, most commonly aseptic loosening (n = 6, 14%). With death as a competing risk, the cumulative incidence of mechanical failure was 28% at 2-years postoperative. Following the procedure, mean Musculoskeletal Tumor Society scores was 70% and mean shoulder elevation was 87°. CONCLUSION Reconstruction of the humeral diaphysis with an intercalary endoprosthesis provides restoration of function of the upper extremity, however, is associated with one in four patients having mechanical failure.
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Affiliation(s)
- Joshua R Labott
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark J Heidenreich
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel E Broida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gavin L Mills
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Holzer LA, Finsterwald MA, Sobhi S, Jones CW, Yates PJ. Application of bone cement directly to the implant in primary total knee arthroplasty. Short-term radiological and clinical follow-up of two different cementing techniques. Arch Orthop Trauma Surg 2024; 144:333-340. [PMID: 37736767 DOI: 10.1007/s00402-023-05057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/02/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE This study aimed to optimize cement application techniques in fully cemented primary total knee arthroplasty (TKA) by comparing the effects of two different approaches: cement on bone surface (CoB) versus cement on bone surface and implant surface (CoBaI) on the short-term presence of radiolucent lines (RLL) as indicators of potential complications. METHODS In this monocentric study, a total of 379 fully cemented primary TKAs (318 patients) were included. The two study groups were differentiated by the technique of cement application: CoB group (cement applied only on bone surface) and CoBaI group (cement applied on both bone surface and implant surface). The presence of RLL or osteolysis was evaluated using the updated Knee Society Radiographic Evaluation System. RESULTS In the whole study population, RLL were present in 4.7% of cases, with a significantly higher incidence in the CoBaI group (10.5%) at the 4-week follow-up. At the 12-month follow-up, RLL were observed in 29.8% of TKAs in the CoBaI group, while the incidence was lower in the CoB group (24.0%) (not statistically significant). There were two revisions in each group, none of which were due to aseptic loosening. CONCLUSION The findings of this study suggest that the application of bone cement on bone surface only (CoB) may be more beneficial than applying it on both bone surface and implant surface (CoBaI) in terms of short-term presence of RLL in fully cemented primary TKA. Long-term results, especially with regard to aseptic loosening, will be of interest and may provide valuable guidance for future directions in bone cement applications in TKA.
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Affiliation(s)
- Lukas A Holzer
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia.
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia.
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Michael A Finsterwald
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
| | - Salar Sobhi
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
| | - Christopher W Jones
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
- Curtin University, Bentley, WA, Australia
- University of Western Australia, Crawley, WA, Australia
| | - Piers J Yates
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, 11 Robin Warren Dr., Murdoch, WA, 6150, Australia
- Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
- University of Western Australia, Crawley, WA, Australia
- Department of Orthopaedics, St. John of God Hospital Murdoch, Murdoch, WA, Australia
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Eckert JA, Bitsch RG, Schroeder S, Schwarze M, Jaeger S. Pulsatile Lavage Improves Tibial Cement Penetration and Implant Stability in Medial Unicompartmental Arthroplasty: A Cadaveric Study. J Knee Surg 2023; 36:417-423. [PMID: 34507360 DOI: 10.1055/s-0041-1735310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cemented unicompartmental knee arthroplasty (UKA) shows good survivorship and function. However, implant failure, causing the need for revision, can occur. Aseptic loosening is still among the most common reasons for revision. The purpose of this study was to assess the influence of preimplantation lavage technique on tibial cement penetration depth, tibial cement volume, and load to fracture in the tibial component of mobile-bearing UKA. In 10 pairs of fresh frozen human tibiae, cemented UKA was implanted by an experienced surgeon. Tibial components were then implanted, left and right tibiae were randomly allocated to group A or B. Prior to implantation, irrigation was performed with either syringe lavage or pulsatile jet lavage in a standardized manner. Cement surface was 4170.2 mm2 (3271.6-5497.8 mm2) in the syringe lavage group, whereas the jet lavage group showed 4499.3 mm2 (3354.3-5809.1 mm2); cement volume was significantly higher as well (4143.4 mm3 (2956.6-6198.6 mm3) compared with 5936.9 mm3 (3077.5-8183.1 mm3)). Cement penetration depth was 2.5 mm (1.7-3.2 mm) for the jet lavage, and 1.8 mm (1.2-2.4 mm) for the syringe lavage. The mean fracture load was 4680 N in the jet lavage group and 3800 N in the syringe lavage group (p = 0.001). Subsidence was significantly higher for syringe lavage. This study suggests a correlation of cement penetration depth and cement volume to implant failure in the tibial component of a UKA using a cadaveric model. The type of bone lavage most likely influences these two key parameters.
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Affiliation(s)
- Johannes A Eckert
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Gelenkzentrum in der ATOS Klinik Heidelberg GmbH & Co. KG, Heidelberg, Germany
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schwarze
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
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El-Othmani MM, Zalikha AK, Cooper HJ, Shah RP. Femoral Stem Cementation in Primary Total Hip Arthroplasty. JBJS Rev 2022; 10:01874474-202210000-00005. [PMID: 36215391 DOI: 10.2106/jbjs.rvw.22.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
➢ Femoral stem cementation has undergone considerable investigation since bone cement was first used in arthroplasty, leading to the evolution of modern femoral stem cementation techniques. ➢ Although there is a worldwide trend toward the use of cementless components, cemented femoral stems have shown superiority in some studies and have clear indications in specific populations. ➢ There is a large evidence base regarding cement properties, preparation, and application techniques that underlie current beliefs and practice, but considerable controversy still exists. ➢ Although the cementing process adds technical complexity to total hip arthroplasty, growing evidence supports its use in certain cohorts. As such, it is critical that orthopaedic surgeons and investigators have a thorough understanding of the fundamentals and evidence underlying modern cementation techniques.
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Affiliation(s)
- Mouhanad M El-Othmani
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York
| | - Abdul K Zalikha
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, Michigan
| | - H John Cooper
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York
| | - Roshan P Shah
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York
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Hinarejos P, Fontanellas A, Leal-Blanquet J, Sánchez-Soler J, Torres-Claramunt R, Monllau JC. The technique of cement application has no influence on cement intrusion in total knee arthroplasty: randomized study comparing three different techniques. Knee Surg Sports Traumatol Arthrosc 2022; 30:1057-1064. [PMID: 33715056 DOI: 10.1007/s00167-021-06528-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of the study was to compare the distance of intrusion of the cement into the bone in different areas both in the femur and the tibia in vivo, measured in the radiograph after implanting a total knee arthroplasty (TKA) with three different cement techniques. METHODS A prospective randomized study of 90 consecutive patients operated on at our institution with a cemented U2 Knee System TKA and medium viscosity Simplex P® bone cement. After pulse lavage, the cement was applied on the bone surfaces (group 1), on the implant surfaces (group 2) or both on the bone and the implant surfaces (group 3). The cement intrusion was measured in the postoperative radiographs in eight different regions in the tibial component and in six regions in the femoral component. The cement employed was calculated by weighting the cement after mixing and weighting the discarded cement. RESULTS The average intrusion of the cement was similar in all three groups of cementing techniques in the femoral components (1.6 mm; p = 0.386), and in the tibial components (2.6 mm; p = 0.144). The intrusion of the cement in the tibia was greater in women than in men (p = 0.04). We used 21.1 (SD 5.8) g of cement in average. The amount of cement employed was greater when the cement was applied on both (implant and bone) surfaces (group 3: 24.03 g in average) than when it was applied only on the bone (group 1: 20.13 g; p = 0.01) or only on the implants (group 2: 19.20 g; p = 0.001). The amount of cement employed was greater in men than in women (p = 0.002) and it was also greater when a PS femoral component was used (p = 0.03). The amount of cement employed was directly correlated with the height of the patients (p = 0.01) and with the bigger size of the components (p < 0.001). CONCLUSION All three cement application techniques have similar intrusion distance of the cement into the bone, and the intrusion depth of the cement into the trabecular tibial bone is greater than the minimum suggested for fixation.
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Affiliation(s)
- Pedro Hinarejos
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain. .,Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Albert Fontanellas
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain.,Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Joan Leal-Blanquet
- Department of Orthopedic Surgery, Hospital d'Igualada, Consorci Sanitari de l'Anoia, Av. Catalunya, 11, 08700, Igualada, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
| | - Juan Carlos Monllau
- Department of Orthopedic Surgery, Parc de Salut Mar, Hospital de l'Esperança, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain.,Universitat Autonoma de Barcelona, Barcelona, Spain
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Knappe K, Bitsch RG, Schonhoff M, Walker T, Renkawitz T, Jaeger S. Pulsatile Lavage Systems with High Impact Pressure and High Flow Produce Cleaner Cancellous Bone Prior to Cementation in Cemented Arthroplasty. J Clin Med 2021; 11:88. [PMID: 35011832 PMCID: PMC8745275 DOI: 10.3390/jcm11010088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
In cemented joint arthroplasty, state-of-the-art cementing techniques include high-pressure pulsatile saline lavage prior to cementation. Even with its outstanding importance in cementation, there are surprisingly few studies regarding the physical parameters that define pulsatile lavage systems. To investigate the parameters of impact pressure, flow rate, frequency and the cleaning effect in cancellous bone, we established a standardized laboratory model. Standardized fat-filled carbon foam specimens representing human cancellous bone were cleaned with three different high-pressure pulsatile lavage systems. Via CT scans before and after cleaning, the cleaning effect was evaluated. All systems showed a cleaning depth of at least 3.0 mm and therefore can be generally recommended to clean cancellous bone in cemented joint arthroplasty. When comparing the three lavage systems, the study showed significant differences regarding cleaning depths and volume, with one system being superior to its peer systems. Regarding the physical parameters, high impact pressure in combination with high flow rate and longer distance to the flushed object seems to be the best combination to improve the cleaning of cancellous bone and therefore increase the chances of a deeper cement penetration that is required in cemented joint arthroplasty. In summary, this study provides the first standardized comparison of different lavage systems and thus gives initial guidance on how to optimally prepare cancellous bone for cemented joint arthroplasty.
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Affiliation(s)
- Kevin Knappe
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (T.W.); (T.R.)
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | | | - Mareike Schonhoff
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
| | - Tilman Walker
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (T.W.); (T.R.)
| | - Tobias Renkawitz
- Department of Orthopedic Surgery, Heidelberg University, 69118 Heidelberg, Germany; (T.W.); (T.R.)
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University, 69118 Heidelberg, Germany; (M.S.); (S.J.)
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Bösebeck H, Holl AM, Ochsner P, Groth M, Stippich K, Nowakowski AM, Egloff C, Hoechel S, Göpfert B, Vogt S. Cementing technique for total knee arthroplasty in cadavers using a pastry bone cement. J Orthop Surg Res 2021; 16:417. [PMID: 34210335 PMCID: PMC8247244 DOI: 10.1186/s13018-021-02436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 04/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background In cemented primary total knee arthroplasty (TKA), aseptic loosening remains a major cause for failure. Cementing techniques and characteristics of a chosen cement play a key role for good fixation and implant survival. A pastry bone cement was developed to facilitate the cement preparation and to rule out most of preparation-associated application errors. The pastry bone cement was compared to a conventional polymethyl methacrylate cement in a TKA setting. Methods Standardized implantations of total knee endoprostheses were performed in bilateral knee cadavers to investigate handling properties, variables of cement application, working time, and temperature development. Mechanical aspects and cementation quality were assessed by pull-out trials and microscopic interface analysis. Results Both cements expressed similar characteristics during preparation and application, only the curing time of the pastry cement was about 3 min longer and the temperature peak was lower. Fractures of the conventional cement specimens differed from the pastry cement specimens in the tibial part, while no differences were found in the femoral part. Penetration depth of the pastry cement was similar (tibia) or deeper (femur) compared to the conventional cement. Conclusions The pastry cement facilitates the feasibility of cemented TKA. The pre-clinical tests indicate that the pastry bone cement fulfills the requirements for bone cement in the field of knee arthroplasty. A clinical trial is needed to further investigate the approach and ensure patient safety. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02436-z.
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Affiliation(s)
- Hans Bösebeck
- Heraeus Medical GmbH, Philipp-Reiss-Strasse 8/13, 61273, Wehrheim, Germany.
| | - Anna-Maria Holl
- Heraeus Medical GmbH, Philipp-Reiss-Strasse 8/13, 61273, Wehrheim, Germany
| | - Peter Ochsner
- Universitätsspital Basel, Orthopädie, Rüttigasse 7, 4402, Frenkendorf,, Switzerland
| | - Manuel Groth
- Heraeus Medical GmbH, Philipp-Reiss-Strasse 8/13, 61273, Wehrheim, Germany
| | - Kevin Stippich
- Heraeus Medical GmbH, Philipp-Reiss-Strasse 8/13, 61273, Wehrheim, Germany
| | | | - Christian Egloff
- Universitätsspital Basel, Orthopädie, Spitalstrasse 21, 4053, Basel, Switzerland
| | - Sebastian Hoechel
- University of Basel, Musculoskeletal Research, Pestalozzistrasse 20, 4056, Basel, Switzerland
| | - Beat Göpfert
- University of Basel, Department Biomedical Engineering, Gewerbestrasse 14, 4123, Allschwil, Switzerland
| | - Sebastian Vogt
- Heraeus Medical GmbH, Philipp-Reiss-Strasse 8/13, 61273, Wehrheim, Germany
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Purcell P, Tyndyk M, McEvoy F, Tiernan S, Sweeney D, Morris S. A Multiscale Finite Element Analysis of Balloon Kyphoplasty to Investigate the Risk of Bone-Cement Separation In Vivo. Int J Spine Surg 2021; 15:302-314. [PMID: 33900988 DOI: 10.14444/8040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the past decade there has been a significant increase in the number of vertebral fractures being treated with the balloon kyphoplasty procedure. Although previous investigations have found kyphoplasty to be an effective treatment for reducing patient pain and lowering cement-leakage risk, there have been reports of vertebral recollapse following the procedure. These reports have indicated evidence of in vivo bone-cement separation leading to collapse of the treated vertebra. METHODS The following study documents a multiscale analysis capable of evaluating the risk of bone-cement interface separation during lying, standing, and walking activities following balloon kyphoplasty. RESULTS Results from the analysis found that instances of reduced cement interlock could initiate both tensile and shear separation of the interface region at up to 7 times the failure threshold during walking or up to 1.9 times the threshold during some cases for standing. Lying prone offered the best protection from interface failure in all cases, with a minimum safety factor of 2.95. CONCLUSIONS The results of the multiscale analysis show it is essential for kyphoplasty simulations to take account of the micromechanical behavior of the bone-cement interface to be truly representative of the in vivo situation after the treatment. The results further illustrate the importance of ensuring adequate cement infiltration into the compacted bone periphery during kyphoplasty through a combination of new techniques, tools, and biomaterials in a multifaceted approach to solve this complex challenge.
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Affiliation(s)
- Philip Purcell
- Bioengineering Technology Centre, Technological University Dublin, Tallaght Campus, Dublin, Ireland.,CADFEM Ireland, The Steelworks, Dublin, Ireland.,Department of Electronic and Mechanical Engineering, Dundalk Institute of Technology, Dundalk, Ireland
| | | | - Fiona McEvoy
- Bioengineering Technology Centre, Technological University Dublin, Tallaght Campus, Dublin, Ireland
| | - Stephen Tiernan
- Bioengineering Technology Centre, Technological University Dublin, Tallaght Campus, Dublin, Ireland
| | | | - Seamus Morris
- Mater Misericordiae University Hospital, National Spinal Injuries Unit, Ireland
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Emara AK, Ng M, Krebs VE, Bloomfield M, Molloy RM, Piuzzi NS. Femoral Stem Cementation in Hip Arthroplasty: The Know-How of a "Lost" Art. Curr Rev Musculoskelet Med 2021; 14:47-59. [PMID: 33453016 PMCID: PMC7930165 DOI: 10.1007/s12178-020-09681-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW To describe the (1) indications, (2) preoperative precautions, and (3) stepwise technical details of modern femoral stem cemented fixation. RECENT FINDINGS Femoral stem cementation provides excellent implant longevity with a low periprosthetic fracture rate among patients with compromised bone quality or aberrant anatomy. Unfamiliarity with the details of modern cementation techniques among trainees who may lack frequent exposure to cementing femoral stems may preclude them from offering this viable option to suitable patients in later stages of their careers. As such, maximizing benefit from cemented femoral stem fixation among suitable candidates is contingent upon the meticulous use of modern cementation techniques. In addition to proper patient selection, modern cementation techniques emphasize the use of (1) pulsatile lavage of the femoral canal, (2) utilization of epinephrine-soaked swabs, (3) vacuum cement mixing, (4) retrograde cement introduction, (5) cement pressurization, and (6) the use of stem centralizers. Furthermore, identifying and optimizing the preoperative status of at-risk patients with pre-existing cardiopulmonary compromise, in addition to intraoperative vigilance, are essential for mitigating the risk of developing bone cement implantation syndrome. Further research is required to assess the utility of cemented femoral stem fixation among younger patients.
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Affiliation(s)
- Ahmed K Emara
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Mitchell Ng
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Viktor E Krebs
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | | | - Robert M Molloy
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, OH, USA.
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Ghouchani A, Rouhi G, Ebrahimzadeh MH. Post-operative fracture risk assessment following tumor curettage in the distal femur: a hybrid in vitro and in silico biomechanical approach. Sci Rep 2020; 10:21319. [PMID: 33288803 PMCID: PMC7721712 DOI: 10.1038/s41598-020-78188-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022] Open
Abstract
The distal femur is the predominant site for benign bone tumours and a common site for fracture following tumour removal or cementation. However, the lack of conclusive assessment criterion for post-operative fracture risk and appropriate devices for cement augmentation are serious concerns. Hence, a validated biomechanical tool was developed to assess bone strength, depending on the size and location of artificially created tumorous defects in the distal femora. The mechanics of the bone–cement interface was investigated to determine the main causes of reconstruction failure. Based on quantitative-CT images, non-linear and heterogeneous finite element (FE) models of human cadaveric distal femora with simulated tumourous defects were created and validated using in vitro mechanical tests from 14 cadaveric samples. Statistical analyses demonstrated a strong linear relationship (R2 = 0.95, slope = 1.12) with no significant difference between bone strengths predicted by in silico analyses and in vitro tests (P = 0.174). FE analyses showed little reduction in bone strength until the defect was 35% or more of epiphyseal volume, and reduction in bone strength was less pronounced for laterally located defects than medial side defects. Moreover, the proximal end of the cortical window and the most interior wall of the bone–cement interface were the most vulnerable sites for reconstruction failure.
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Affiliation(s)
- Azadeh Ghouchani
- Faculty of Biomedical Engineering, Amirkabir University of Technology, No. 350, Hafez Ave, Valiasr Square, 1591634311, Tehran, Iran
| | - Gholamreza Rouhi
- Faculty of Biomedical Engineering, Amirkabir University of Technology, No. 350, Hafez Ave, Valiasr Square, 1591634311, Tehran, Iran.
| | - Mohammad Hosein Ebrahimzadeh
- Orthopaedic Research Center, Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Ghaem Hospital, Ahmad Abad Street, Mashhad, Iran
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Innocenti B, Bori E. Change in knee biomechanics during squat and walking induced by a modification in TKA size. J Orthop 2020; 22:463-472. [PMID: 33093756 DOI: 10.1016/j.jor.2020.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/04/2020] [Indexed: 01/17/2023] Open
Abstract
The purpose of this study is to analyze the effects of TKA under-dimensioning during daily activities. A regular ("control") size and an undersized design of the same fixed bearing asymmetric PS prosthesis were analyzed during walking and squat using finite element analysis. The two models showed similar internal-external rotations and antero-posterior displacements during both activities. Slightly higher displacements, wider contact areas and lower contact pressure were found in the control size. Post-cam engagement angles were similar on both sizes. Changes in TKA size slightly affected knee kinematics and kinetics, with post-cam related differences leading to minor changes in kinetic patterns.
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Affiliation(s)
- Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium
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14
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Innocenti B. High congruency MB insert design: stabilizing knee joint even with PCL deficiency. Knee Surg Sports Traumatol Arthrosc 2020; 28:3040-3047. [PMID: 31696240 DOI: 10.1007/s00167-019-05764-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE PCL management and choice of insert design and mobility in total knee arthroplasty are still debated in the literature. Consequently, the purpose of this study was to analyze the biomechanics of a fixed and a mobile bearing total knee arthroplasty with conventional and ultra-congruent insert during walking and squat activities, using finite element analysis, and to check the performance in a knee with healthy and deficient PCL. METHODS The study was based on an already validated and published knee model. Fixed bearing and mobile bearing cruciate-retain designs were selected for this study. Implant kinematics and kinetics were calculated, following previously experimental tests, during a walking cycle and a loaded squat in a knee with intact and with deficient PCL. RESULTS Mobile bearing design, due to its higher congruency, was able to complete the task in intact and deficient PCL conditions, with similar internal-external femoral rotation and with a slight higher anterior translation of the one of the intact knees. Such outcomes were also in agreement with the results of different experimental studies of native knee specimens under similar boundary conditions. Contrariwise, fixed bearing design was able to accomplish the task only in healthy PCL conditions. CONCLUSION Results demonstrated how the high congruency of the mobile bearing design is able to guarantee proper knee stability and kinematics even when the PCL is deficient. Instead, the fixed bearing insert, with lower congruency, is not able, in the absence of the PCL, to stabilize the joint inducing irregular kinematic pattern and component dislocation. Surgeons will have to consider these findings to guarantee the best outcome for the patient and the related change in stability in case of PCL deficiency.
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Affiliation(s)
- Bernardo Innocenti
- École Polytechnique de Bruxelles, BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Brussels, Belgium.
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15
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Verburg H, van Zeeland Koobs L, Niesten DD, Pilot P, Mathijssen N. Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty. BMC Musculoskelet Disord 2020; 21:374. [PMID: 32532306 PMCID: PMC7291566 DOI: 10.1186/s12891-020-03390-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the reliability of two different techniques for measuring penetration and distribution of the cement mantle in the proximal tibia after total knee arthroplasty (TKA) with Computer Tomography (CT) in vivo. METHODS Standardized CT scans of the proximal tibia were taken 1 to 2 years after total knee arthroplasties implanted with a surface cementing technique. These prospectively acquired transversal CT images of the surface of the proximal tibia were divided into four quadrants and were assessed once manually and once with a numerical computing program (MATLAB® Update 2, The MathWorks, Inc.) based on Hounsfield Units by one of the researchers. The assessments were repeated by the same and a second researcher. The ratio cement/trabecular bone was calculated 1, 3 and 5 mm distal of the tibia tray per quadrant. Kruskall-Wallis tests with multiple pairwise comparisons (Dunn's test) were used to determine differences between the quadrants. Intra- and inter-rater reliability as well as the inter method reliability were assessed with the Intraclass Correlation Coefficient (ICC) per level of depth and with Bland-Altman plots. RESULTS A total of 92 CT scans were included. The intra- and inter-rater reliability of the manual method ranged from 0.22 and 0.52. The intra- and inter-rater reliability of the matlab method varied between 0.98 to 0.99. The median percentage cement measured with the matlab method 1 mm underneath the tibial tray varied between 82 and 88%; at 3 mm depth between 38 and 54% and at 5 mm between 15 and 25%. There was significantly (p < 0.05) less cement in the antero-medial quadrant compared to the antero-lateral and postero-lateral quadrant at 3 mm and 5 mm depth. CONCLUSIONS Distribution and penetration of cement in the proximal tibia in a total knee arthroplasty can be measured reliably with CT in combination with the matlab method presented in this manuscript. This method can be used for clinical purposes as well as for scientific research. TRIAL REGISTRATION METC-nr: 06-104 Dossier NL14807.098.06/versie 06.
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Affiliation(s)
- Hennie Verburg
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625, AD, Delft, The Netherlands.
| | - Linda van Zeeland Koobs
- Department of Radiology, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625, AD, Delft, The Netherlands
| | - Dieu Donné Niesten
- Department of Orthopaedic Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625, AD, Delft, The Netherlands
| | - Peter Pilot
- Department of Orthopaedic Research, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625, AD, Delft, The Netherlands
| | - Nina Mathijssen
- Department of Orthopaedic Research, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625, AD, Delft, The Netherlands
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16
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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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17
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Refsum AM, Nguyen UV, Gjertsen JE, Espehaug B, Fenstad AM, Lein RK, Ellison P, Høl PJ, Furnes O. Cementing technique for primary knee arthroplasty: a scoping review. Acta Orthop 2019; 90:582-589. [PMID: 31452416 PMCID: PMC6844414 DOI: 10.1080/17453674.2019.1657333] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The optimal cementing technique for primary total knee arthroplasty (TKA) remains unclear. We therefore performed a scoping review based on available studies regarding cementation technique in primary TKA and unicondylar knee arthroplasty (UKA).Patients and methods - A search in 3 databases identified 1,554 studies. The inclusion criteria were literature that studied cementing technique in primary TKA or UKA. This included cement application methods, full or surface cementing, applying cement to the bone and/or prosthesis, stabilization of the implant during curing phase, bone irrigation technique, drilling holes in the bone, use of suction, and the timing of cementation. 57 studies met the inclusion criteria.Results - The evidence was unanimously in favor of pulsatile lavage irrigation, drying the bone, and drilling holes into the tibia during a TKA. All studies concerning suction recommended it during TKA cementation. 7 out of 11 studies favored the use of a cement gun and no studies showed that finger packing was statistically significantly better than using a cement gun. There is evidence that full cementation should be used if metal-backed tibial components are used. Applying the cement to both implant and bone seems to give better cement penetration.Interpretation - There are still many knowledge gaps regarding cementing technique in primary TKA. There seems to be sufficient evidence to recommend pulsatile lavage irrigation of the bone, drilling multiple holes, and drying the bone before cementing and implant insertion, and applying cement to both implant and on the bone.
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Affiliation(s)
- Anders M Refsum
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen;
| | - Uy V Nguyen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen;
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; ,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen;
| | - Anne M Fenstad
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Regina K Lein
- Medical Library, University of Bergen, Bergen, Norway
| | - Peter Ellison
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Paul J Høl
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; ,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Ove Furnes
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; ,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Correspondence:
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18
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Song Y, Zhu F, Lin F, Zhang F, Zhang S. Bone quality, and the combination and penetration of cement-bone interface: A comparative micro-CT study of osteoarthritis and rheumatoid arthritis. Medicine (Baltimore) 2018; 97:e11987. [PMID: 30170401 PMCID: PMC6392652 DOI: 10.1097/md.0000000000011987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare the microstructure, bone quality, and the combination and penetration of cement-bone interface in tissue specimens from patients with osteoarthritis (OA) and rheumatoid arthritis (RA).A total of 80 femoral condyle tissue specimens from 20 OA patients (40 condyles) and 20 RA patients (40 condyles) who underwent total knee arthroplasty at the Department of Orthopaedics in Tengzhou Central People's Hospital were collected between January 2017 and September 2017. According to the random number table method, 20 specimens from the OA group were defined as group A, and 20 specimens in the RA group were defined as group B. The bone quality parameters were measured by micro-CT. The remaining 20 specimens in the OA group and the remaining 20 specimens in the RA group were defined as group C and group D, the cement-bone interfaces were established by the self-made bone cement compression device, and were analyzed by micro-CT.Micro-CT measurement revealed that the bone volume fraction (BV/TV), trabecular thickness (Tb.Th), and trabecular number (Tb.N) in group A were significantly higher than those in group B (all P < .05). The bone surface/bone volume (BS/BV), structure model index (SMI), trabecular separation (Tb.Sp), and degree of anisotropy (DA) in group A were significantly lower than those in group B (all P < .05). The penetration depth of bone cement in group D was significantly greater than those in group C via x-ray detection.The bone quality of OA patients is better than that of RA patients, but the combination and penetration of cement-bone interface of RA patients are better than that of OA patients. The findings advance our understanding of knee prosthesis and have important clinical implications, but they require validations in future studies with larger sample sizes.
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19
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Innocenti B, Fekete G, Pianigiani S. Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty. J Biomech Eng 2018; 140:2694847. [PMID: 30098138 DOI: 10.1115/1.4040966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/08/2022]
Abstract
Augments are a common solution for treating bone loss in revision total knee arthroplasty and industry is providing to surgeons several options, in terms of material, thickness and shapes. Actually, while the choice of the shape and the thickness is mainly dictated by the bone defect, no proper guidelines are currently available to select the optimal material for a specific clinical situation. Nevertheless, different materials could induce different bone responses and, later, potentially compromise implant stability and performances. Therefore, in this study, a biomechanical analysis is performed by means of finite element modelling about existing features for augment designs. Based upon a review of available products at present, the following augments features were analyzed: position (distal/proximal and posterior), thickness (5, 10 and 15 mm) and material (bone cement, porous and solid metal). For all analyzed configurations, bone stresses were investigated in different regions and compared among all configurations and the control model for which no augments were used. Results show that the use of any kind of augment usually induces a change in bone stresses, especially in the region close to the bone cut. The porous metal presents result very close to cement ones; thus it could be considered as a good alternative for defects of any size. Solid metal has the least satisfying results inducing the highest changes in bone stress. The results of this study demonstrate that material stiffness of the augment should be as close as possible to bone properties for allowing the best implant performances.
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Affiliation(s)
- Bernardo Innocenti
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
| | - Gusztáv Fekete
- Savaria Institute of Technology, Faculty of Informatics, Eötvös Loránd University, Károlyi Gáspár 4, 9700 Szombathely, Hungary
| | - Silvia Pianigiani
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
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20
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Lorenz A, Leichtle CI, Frantz S, Bumann M, Tsiflikas I, Shiozawa T, Leichtle UG. Pull out Strength of Dual Outer Diameter Pedicle Screws Compared to Uncemented and Cemented Standard Pedicle Screws: A Biomechanical in vitro Study. Orthop Surg 2017; 9:229-236. [PMID: 28547867 DOI: 10.1111/os.12322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/26/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To analyze the potential of the dual outer diameter screw and systematically evaluate the pull-out force of the dual outer diameter screw compared to the uncemented and cemented standard pedicle screws with special regard to the pedicle diameter and the vertebra level. METHODS Sixty vertebrae of five human spines (T 6 -L 5 ) were sorted into three study groups for pairwise comparison of the uncemented dual outer diameter screw, the uncemented standard screw, and the cemented standard screw, and randomized with respect to bone mineral density (BMD) and vertebra level. The vertebrae were instrumented, insertion torque was determined, and pull-out testing was performed using a material testing machine. Failure load was evaluated in pairwise comparison within each study group. The screw-to-pedicle diameter ratio was determined and the uncemented dual outer diameter and standard screws were compared for different ratios as well as vertebra levels. RESULTS Significantly increased pull-out forces were measured for the cemented standard screw compared to the uncemented standard screw (+689 N, P < 0.001) and the dual outer diameter screw (+403 N, P < 0.001). Comparing the dual outer diameter screw to the uncemented standard screw in the total study group, a distinct but not significant increase was measured (+149 N, P = 0.114). Further analysis of these two screws, however, revealed a significant increase of pull-out force for the dual outer diameter screw in the lumbar region (+247 N, P = 0.040), as well as for a screw-to-pedicle diameter ratio between 0.6 and 1 (+ 488 N, P = 0.028). CONCLUSIONS For clinical application, cement augmentation remains the gold standard for increasing screw stability. According to our results, the use of a dual outer diameter screw is an interesting option to increase screw stability in the lumbar region without cement augmentation. For the thoracic region, however, the screw-to-pedicle diameter should be checked and attention should be paid to screw cut out, if the dual outer diameter screw is considered.
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Affiliation(s)
- Andrea Lorenz
- Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Carmen I Leichtle
- Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany.,Spine and Orthopaedic Surgery, Rottenburg, Germany
| | - Sandra Frantz
- Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Marte Bumann
- Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Ilias Tsiflikas
- Department of Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Shiozawa
- Department of Clinical Anatomy and Cell Analytics, Institute of Anatomy, University of Tübingen, Tübingen, Germany
| | - Ulf G Leichtle
- Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany
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21
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Vertullo CJ, Nagarajan M. Is cement penetration in TKR reduced by not using a tourniquet during cementation? A single blinded, randomized trial. J Orthop Surg (Hong Kong) 2017; 25:2309499016684323. [PMID: 28139192 DOI: 10.1177/2309499016684323] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite suggestions that tourniquet inflation during total knee replacement reduces bleeding and hence improves cement penetration, no studies exist supporting this widely held belief. In this single-blinded, single-surgeon, randomized controlled trial, the tourniquet inflation during cementation group ( n = 20) did not have greater tibial cement penetration compared to a no tourniquet group ( n = 20). No statistically significant differences in semiautomatic digitally measured average and central radiographic tibial plateau penetration values were observed between the two groups ( p = 0.93; p = 0.84). Tourniquet inflation during cementation does not appear to improve tibial cementation penetration.
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Affiliation(s)
- Christopher John Vertullo
- 1 Knee Research Australia, Orthopaedic Surgery and Sports Medicine Centre, Benowa, QLD, Australia.,2 Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Manickaraj Nagarajan
- 1 Knee Research Australia, Orthopaedic Surgery and Sports Medicine Centre, Benowa, QLD, Australia
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22
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Brihault J, Navacchia A, Pianigiani S, Labey L, De Corte R, Pascale V, Innocenti B. All-polyethylene tibial components generate higher stress and micromotions than metal-backed tibial components in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2550-9. [PMID: 25957612 DOI: 10.1007/s00167-015-3630-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 04/29/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE Most total knee arthroplasty tibial components are metal-backed, but an alternative tibial component made entirely of polyethylene (all-polyethylene design) exists. While several clinical studies have shown that all-poly design performs similarly to the metal-backed, the objective of this study is to perform a biomechanical comparison. METHODS Loads, constraints and geometries during a squat activity at 120° of flexion were obtained from a validated musculoskeletal model and applied to a finite element model. Stresses in the tibia and micromotions at the bone-implant interface were evaluated for several implant configurations: (1) three different thicknesses of the cement penetration under the baseplate (2, 3 and 4 mm), (2) the presence or absence of a cement layer around the stem of the tibial tray and (3) three different bone conditions (physiological, osteopenic and osteoporotic bone). RESULTS All-polyethylene tibial components resulted in significantly higher (p < 0.001) and more uneven stress distributions in the cancellous bone under the baseplate (peak difference: +128.4 %) and fivefold increased micromotions (p < 0.001). Performance of both implant designs worsened with poorer bone quality with peaks in stress and micromotion variations of +40.8 and +54.0 %, respectively (p < 0.001). Performance improvements when the stem was cemented were not statistically significant (n.s.). CONCLUSION The metal-backed design showed better biomechanical performance during a squat activity at 120° of flexion compared to the all-polyethylene design. These results should be considered when selecting the appropriate tibial component for a patient, especially in the presence of osteoporotic bone or if intense physical activity is foreseen.
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Affiliation(s)
- Jean Brihault
- Faculté de Médicine, Université F. Rabelais, Tours, France
| | - Alessandro Navacchia
- Department of Industrial Engineering, University of Bologna, Bologna, Italy.
- Computational Biomechanics Lab, University of Denver, 2390 S. York Street, Denver, CO, 80208, USA.
| | | | - Luc Labey
- European Centre for Knee Research, Smith&Nephew, Louvain, Belgium
- Mechanical Engineering Technology TC, Campus Geel, KU Leuven, Louvain, Belgium
| | - Ronny De Corte
- European Centre for Knee Research, Smith&Nephew, Louvain, Belgium
| | | | - Bernardo Innocenti
- European Centre for Knee Research, Smith&Nephew, Louvain, Belgium
- BEAMS Department, Université Libre de Bruxelles, Avenue Franklin Roosevelt, 50, Bruxelles, 1050, Belgium
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Zhang CL, Shen GQ, Zhu KP, Liu DX. Biomechanical effects of morphological variations of the cortical wall at the bone-cement interface. J Orthop Surg Res 2016; 11:72. [PMID: 27369636 PMCID: PMC4929745 DOI: 10.1186/s13018-016-0405-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The integrity of bone-cement interface is very important for the stabilization and long-term sustain of cemented prosthesis. Variations in the bone-cement interface morphology may affect the mechanical response of the shape-closed interlock. METHODS Self-developed new reamer was used to process fresh pig reamed femoral canal, creating cortical grooves in the canal wall of experimental group. The biomechanical effects of varying the morphology with grooves of the bone-cement interface were investigated using finite element analysis (FEA) and validated using companion experimental data. Micro-CT scans were used to document interlock morphology. RESULTS The contact area of the bone-cement interface was greater (P < 0.05) for the experimental group (5470 ± 265 mm(2)) when compared to the specimens of control group (5289 ± 299 mm(2)). The mechanical responses to tensile loading and anti-torsion showed that the specimens with grooves were stronger (P < 0.05) at the bone-cement interface than the specimens without grooves. There were positively significant correlation between the contact area and the tensile force (r (2) = 0.85) and the maximal torsion (r (2) = 0.77) at the bone-cement interface. The volume of cement of the experimental group (7688 ± 278 mm(3)) was greater (P < 0.05) than of the control group (5764 ± 186 mm(3)). There were positively significant correlations between the volume of cement and the tensile force (r (2) = 0.90) and the maximal torsion (r (2) = 0.97) at the bone-cement interface. The FEA results compared favorably to the tensile and torsion relationships determined experimentally. More cracks occurred in the cement than in the bone. CONCLUSIONS Converting the standard reaming process from a smooth bore cortical tube to the one with grooves permits the cement to interlock with the reamed bony wall. This would increase the strength of the bone-cement interface.
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Affiliation(s)
- Chun-Lin Zhang
- Department of Orthopaedic Surgery, the Tenth People's Hospital Affiliated to Tongji University, #301 Yan-chang Middle Road, Shanghai, 200072, China.
| | - Guo-Qi Shen
- Department of Orthopaedic Surgery, Changshu Second People's Hospital, Changshu, 215500, China
| | - Kun-Peng Zhu
- Department of Orthopaedic Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200233, China
| | - Dong-Xu Liu
- Orthotek Lab, School of Mechatronics Engineering and Automation, Shanghai University, No. 149, Yanchang Rd, 200072, Shanghai, People's Republic of China
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Innocenti B, Bellemans J, Catani F. Deviations From Optimal Alignment in TKA: Is There a Biomechanical Difference Between Femoral or Tibial Component Alignment? J Arthroplasty 2016; 31:295-301. [PMID: 26321075 DOI: 10.1016/j.arth.2015.07.038] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/03/2015] [Accepted: 07/27/2015] [Indexed: 02/01/2023] Open
Abstract
Restoration of neutral mechanical alignment is one of the prerequisites for long-term TKA survival. This study aimed to investigate the effect of deviations from neutral alignment on bone and implant stress and on ligament strain. Using a previously validated finite element model, a neutrally aligned TKA model was compared to 3 different varus and valgus configurations induced by tibial or by femoral component only and by both component simultaneously. Each model underwent a 2500 N vertical load simulating the peak walking force. Varus and valgus alignment increased polyethylene and bone stress, and altered ligament strains, as compared to the neutral aligned model. Changes in alignment of the tibial component were always associated with more detrimental effects compared to the one of the femoral component.
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Affiliation(s)
| | - Johan Bellemans
- Department of Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Fabio Catani
- Orthopaedics and Traumatology Department, Modena Policlinic, Modena, Italy
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Computer Simulation and Analysis on Flow Characteristics and Distribution Patterns of Polymethylmethacrylate in Lumbar Vertebral Body and Vertebral Pedicle. BIOMED RESEARCH INTERNATIONAL 2015; 2015:160237. [PMID: 26770969 PMCID: PMC4685104 DOI: 10.1155/2015/160237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/16/2015] [Indexed: 11/18/2022]
Abstract
This study was designed to analyze the flow and distribution of polymethylmethacrylate (PMMA) in vertebral body through computer simulation. Cadaveric lumbar vertebrae were scanned through electron beam tomography (EBT). The data was imported into Mimics software to build computational model. Vertebral body center and junction of pedicle and vertebral body were chosen as injection points. Silicone oil with viscosity of 100,000 cSt matching with PMMA bone cement was chosen for injection. The flow and distribution of silicone oil were analyzed using Fluent software. In vertebral body, silicone oil formed a circle-like shape centered by injection point on transverse and longitudinal sections, finally forming a sphere-like shape as a whole. Silicone oil diffused along lateral and posterior walls forming a circle-like shape on transverse section centered by injection point in pedicle, eventually forming a sphere-like shape as a whole. This study demonstrated that silicone oil flowed and diffused into a circle-like shape centered by injection point and finally formed a sphere-like shape as a whole in both vertebral body and pedicle. The flow and distribution of silicon oil in computational model could simulate PMMA distribution in vertebral body. It may provide theoretical evidence to reduce PMMA leakage risk during percutaneous vertebroplasty.
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Wee H, Armstrong AD, Flint WW, Kunselman AR, Lewis GS. Peri-implant stress correlates with bone and cement morphology: Micro-FE modeling of implanted cadaveric glenoids. J Orthop Res 2015; 33:1671-9. [PMID: 25929691 PMCID: PMC4591115 DOI: 10.1002/jor.22933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/24/2015] [Indexed: 02/04/2023]
Abstract
Aseptic loosening of cemented joint replacements is a complex biological and mechanical process, and remains a clinical concern especially in patients with poor bone quality. Utilizing high resolution finite element analysis of a series of implanted cadaver glenoids, the objective of this study was to quantify relationships between construct morphology and resulting mechanical stresses in cement and trabeculae. Eight glenoid cadavers were implanted with a cemented central peg implant. Specimens were imaged by micro-CT, and subject-specific finite element models were developed. Bone volume fraction, glenoid width, implant-cortex distance, cement volume, cement-cortex contact, and cement-bone interface area were measured. Axial loading was applied to the implant of each model and stress distributions were characterized. Correlation analysis was completed across all specimens for pairs of morphological and mechanical variables. The amount of trabecular bone with high stress was strongly negatively correlated with both cement volume and contact between the cement and cortex (r = -0.85 and -0.84, p < 0.05). Bone with high stress was also correlated with both glenoid width and implant-cortex distance. Contact between the cement and underlying cortex may dramatically reduce trabecular bone stresses surrounding the cement, and this contact depends on bone shape, cement amount, and implant positioning.
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Affiliation(s)
- Hwabok Wee
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
| | - April D. Armstrong
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
| | - Wesley W. Flint
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
| | - Allen R. Kunselman
- Department of Public Health Sciences, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
| | - Gregory S. Lewis
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine 500 University Drive, Hershey, PA 17033
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Juvonen T, Nuutinen JP, Koistinen AP, Kröger H, Lappalainen R. Biomechanical evaluation of bone screw fixation with a novel bone cement. Biomed Eng Online 2015. [PMID: 26219663 PMCID: PMC4518640 DOI: 10.1186/s12938-015-0069-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Bone cement augmentation is commonly used to improve the fixation stability of orthopaedic implants in osteoporotic bone. The aim of this study was to evaluate the effect of novel bone cements on the stability of bone screw fixation by biomechanical testing and to compare them with a conventional Simplex®P bone cement and requirements of the standards. Methods Basic biomechanical properties were compared with standard tests. Adhesion of bone cements were tested with polished, glass blasted and corundum blasted stainless steel surfaces. Screw pullout testing with/without cement was carried out using a synthetic bone model and cancellous and cortical bone screws. Results All the tested bone cements fulfilled the requirements of the standard for biomechanical properties and improved the screw fixation stability. Even a threefold increase in shear and tensile strength was achieved with increasing surface roughness. The augmentation improved the screw pullout force compared to fixation without augmentation, 1.2–5.7 times depending on the cement and the screw type. The good biomechanical properties of novel bone cement for osteoporotic bone were confirmed by experimental testing. Conclusion Medium viscosity of the bone cements allowed easy handling and well-controlled penetration of bone cement into osteoporotic bone. By proper parameters and procedures it is possible to achieve biomechanically stable fixation in osteoporotic bone. Based on this study, novel biostable bone cements are very potential biomaterials to enhance bone screw fixation in osteoporotic bone. Novel bone cement is easy to use without hand mixing using a dual syringe and thus makes it possibility to use it as required during the operation.
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Affiliation(s)
- Tiina Juvonen
- Department of Applied Physics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.
| | | | - Arto P Koistinen
- Department of Applied Physics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland. .,SIB Labs, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.
| | - Heikki Kröger
- Department of Orthopaedics Traumatology and Handsurgery, Kuopio University Hospital, Kuopio, Finland.
| | - Reijo Lappalainen
- Department of Applied Physics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland. .,SIB Labs, University of Eastern Finland, Kuopio Campus, Kuopio, Finland.
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Jaeger S, Rieger JS, Obermeyer B, Klotz MC, Kretzer JP, Bitsch RG. Cement applicator use for hip resurfacing arthroplasty. Med Eng Phys 2015; 37:447-52. [PMID: 25772262 DOI: 10.1016/j.medengphy.2015.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/04/2015] [Accepted: 02/16/2015] [Indexed: 12/27/2022]
Abstract
We compared the manufacturer recommended cementing technique for a femoral hip resurfacing implant (BHR, S&N) to a newly designed cement applicator on 20 porous carbon foam specimens. Substantial design changes and improvements of the cement applicator were necessary: The diameter and number of the cement escaping holes at the top of the applicator were optimized for medium viscosity cement. It was necessary to add four separate air inlet holes with large diameters. The inner shape of the applicator had to be adapted to the BHR design with a circular extending chamfer in the proximal region, a parallel inner wall and a second chamfer distally. The interface temperatures showed no risk for heat necrosis using both techniques. The cement penetration depth was more uniform and significantly reduced for the applicator cementing technique (4.34 ± 1.42 mm, 6.42 ± 0.43 mm, p = 0.001). The cement-applicator showed no cement defects compared to a large defect length (0.0 ± 0.0 mm, 10.36 ± 1.10 mm, p < 0.001) with the manufacturer recommended cementing technique. The cement applicator technique appears to be effective for a homogenous cement distribution without cement defects and safe with a lower risk of polar over-penetration.
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Affiliation(s)
- Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Johannes S Rieger
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Beate Obermeyer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Matthias C Klotz
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - J Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
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Tozzi G, Zhang QH, Tong J. Microdamage assessment of bone-cement interfaces under monotonic and cyclic compression. J Biomech 2014; 47:3466-74. [DOI: 10.1016/j.jbiomech.2014.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 09/01/2014] [Accepted: 09/14/2014] [Indexed: 11/28/2022]
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The eburnated bone–cement interface. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Beckmann NA, Bitsch RG, Seeger JB, Klotz MCM, Kretzer JP, Jaeger S. Mechanical properties of a cemented porous implant interface. Acta Orthop 2014; 85:531-7. [PMID: 24798109 PMCID: PMC4164873 DOI: 10.3109/17453674.2014.919557] [Citation(s) in RCA: 5] [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 Revision arthroplasty often requires anchoring of prostheses to poor-quality or deficient bone stock. Recently, newer porous materials have been introduced onto the market as additional, and perhaps better, treatment options for revision arthroplasty. To date, there is no information on how these porous metals interface with bone cement. This is of clinical importance, since these components may require cementing to other prosthesis components and occasionally to bone. METHODS We created porous metal and bone cylinders of the same size and geometry and cemented them in a well-established standardized setting. These were then placed under tensile loading and torsional loading until failure was achieved. This permitted comparison of the porous metal/cement interface (group A) with the well-studied bone/cement interface (group B). RESULTS The group A interface was statistically significantly stronger than the group B interface, despite having significantly reduced depth of cement penetration: it showed a larger maximum tensile force (effect size 2.7), superior maximum tensile strength (effect size 2.6), greater maximum torsional force (effect size 2.2), and higher rotational stiffness (effect size 1.5). INTERPRETATION The newer porous implants showed good interface properties when cemented using medium-viscosity bone cement. The axial and rotational mechanical strength of a porous metal/cement interface appeared to be greater than the strength of the standard bone/cement interface. These results indicate that cementing of porous implants can provide great stability in situations where it is needed.
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Affiliation(s)
- Nicholas A Beckmann
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg
| | - Joern B Seeger
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Giessen, Germany
| | - Matthias CM Klotz
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg
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Morishima T, Choy GGH, Crawford RW, Wilson LJ. Comparison of two pressurisers for cementation of the proximal femur. J Orthop Surg (Hong Kong) 2014; 22:163-7. [PMID: 25163947 DOI: 10.1177/230949901402200209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare pressures generated by 2 different cement pressurisers at various locations in the proximal femur. METHODS Two groups of 5 synthetic femurs were used, and 6 pressure sensors were placed in the femur at 20-mm intervals proximally to distally. Cement was filled into the femoral canal retrogradely using a cement gun with either the half-moon pressuriser or the femoral canal pressuriser. Maximum pressures and pressure time integrals (cumulative pressure over time) of the 2 pressurisers were compared. RESULTS At all sensors, the half-moon pressuriser produced higher maximum pressures and pressure time integrals than the femoral canal pressuriser, but the difference was significant only at sensor 1 (proximal femur). This may result in reduced cement interdigitation in the proximal femur. CONCLUSION The half-moon pressuriser produced higher maximum cementation pressures and pressure time integrals than the femoral canal pressuriser in the proximal femur region, which is critical for rotational stability of the implant and prevention of implant fracture.
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Affiliation(s)
- Takkan Morishima
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Goodheart JR, Miller MA, Mann KA. In vivo loss of cement-bone interlock reduces fixation strength in total knee arthroplasties. J Orthop Res 2014; 32:1052-60. [PMID: 24777486 PMCID: PMC4074492 DOI: 10.1002/jor.22634] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/31/2014] [Indexed: 02/04/2023]
Abstract
Prevention of aseptic loosening of total knee arthroplasties (TKAs) remains a clinical challenge. Understanding how changes in morphology at the implant-bone interface with in vivo service affect implant stability and strength could lead to new approaches to mitigate loosening. Enbloc TKA retrievals and freshly-cemented TKA tibial components were used to determine if the mechanical strength of the interface depended on the amount of cement-bone interlock and the morphology of the supporting bone under the cement layer. Implants were sectioned into small specimens of the cement-interface-bone from under the tibial tray. Micro-CT scans were used to document interlock morphology and architecture of the supporting trabecular bone. Axial compression tests were used to assess mechanical behavior. Postmortem retrievals had lower contact fraction (42 ± 55%) compared to freshly-cemented constructs (121 ± 61%) (p = 0.0008). Supporting bone architecture parameters were not different for the two groups. Increased interface contact fraction and supporting bone volume fraction (BV/TV) were positive predictors of interface strength (r(2) = 0.72, p = 0.0001). For the same supporting bone BV/TV, postmortem specimens had weaker interfaces; they were also more compliant. Cemented TKAs with in vivo service experience a loss of fixation strength and increased micro-motion due to the loss of cement-bone interlock.
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Affiliation(s)
- Jacklyn R. Goodheart
- Department of Orthopedic Surgery; State University of New York; Upstate Medical University; 3216 IHP 750 East Adams Street Syracuse New York 13210
| | - Mark A. Miller
- Department of Orthopedic Surgery; State University of New York; Upstate Medical University; 3216 IHP 750 East Adams Street Syracuse New York 13210
| | - Kenneth A. Mann
- Department of Orthopedic Surgery; State University of New York; Upstate Medical University; 3216 IHP 750 East Adams Street Syracuse New York 13210
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Jaeger S, Seeger JB, Schuld C, Bitsch RG, Clarius M. Tibial cementing in UKA: a three-dimensional analysis of the bone cement implant interface and the effect of bone lavage. J Arthroplasty 2013; 28:191-4. [PMID: 23790498 DOI: 10.1016/j.arth.2013.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/12/2013] [Accepted: 05/09/2013] [Indexed: 02/01/2023] Open
Abstract
Loosening is a common cause for revision in cemented UKA. In a cadaver study, we analyzed the three-dimensional cement distribution under the tibial implant and the effect of bone lavage (pulsed lavage, syringe lavage) on maximum cement penetration and penetration volume. Analyses were determined by performing bone cuts in medio-lateral direction and converting this data into a 3D model. Pulsed lavage led to an increased mean maximum cement penetration 5.79 ± 2.63 mm and penetration volume 6471.34 ± 1156.43 mm(3) compared to syringe lavage 4.62 ± 2.61 mm, 5069.81 ± 1177.09 mm(3) (P<0.001; P<0.001). Our results show a complete cement mantle for both investigated lavage techniques. Cleansing the cancellous tibial bone bed using pulsed lavage is more effective than conventional syringe lavage and leads to a deeper cement penetration and lager cement penetration volume under the tibial component.
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Affiliation(s)
- Sebastian Jaeger
- Department of Orthopaedics, Traumatology and Paraplegiology, Heidelberg University Hospital, Laboratory of Biomechanics and Implant Research, Schlierbacher Landstrasse 200a, Heidelberg, Germany
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Soenen M, Baracchi M, De Corte R, Labey L, Innocenti B. Stemmed TKA in a femur with a total hip arthroplasty: is there a safe distance between the stem tips? J Arthroplasty 2013; 28:1437-45. [PMID: 23489732 DOI: 10.1016/j.arth.2013.01.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 12/12/2012] [Accepted: 01/04/2013] [Indexed: 02/01/2023] Open
Abstract
When a stemmed TKA is needed in a femur in which a THA is already present, choosing an appropriate length for the TKA stem is crucial. Many surgeons intuitively fear that the distance between the stem tips correlates with the femur risk for fracture (RF). However, to date, no biomechanical data to support this intuition are available. Therefore, in this study, the RF in such a configuration was determined and compared for several activities, using a finite element modeling technique. During gait and sideways falling no difference in RF among different stem lengths was shown. However, a clear threshold appears during four-point bending. Stem tip distances shorter than 110 mm dramatically increased RF and, in osteoporotic bone, will certainly lead to fracture (RF>1) and thus should be avoided.
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36
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Shi J, Browne M, Strickland M, Flivik G, Taylor M. Sensitivity analysis of a cemented hip stem to implant position and cement mantle thickness. Comput Methods Biomech Biomed Engin 2013; 17:1671-84. [DOI: 10.1080/10255842.2012.761693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Seeger JB, Jaeger S, Bitsch RG, Mohr G, Röhner E, Clarius M. The effect of bone lavage on femoral cement penetration and interface temperature during Oxford unicompartmental knee arthroplasty with cement. J Bone Joint Surg Am 2013; 95:48-53. [PMID: 23283372 DOI: 10.2106/jbjs.k.01116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aseptic loosening is the most common cause for revision unicompartmental knee arthroplasty and is associated with failure of the bone-cement or cement-implant interface. The purpose of the present study was to analyze different bone lavage techniques for the bone-cement and cement-implant interfaces of the femoral component and to study the effect of these techniques on cement penetration and on interface temperature. METHODS In an experimental cadaver study, Oxford unicompartmental knee arthroplasty was performed in twenty-four matched-paired knees to study the effect of pulsed lavage compared with syringe lavage on femoral cement penetration and interface temperature. Interface temperature, cement penetration pressure, and ligament tension forces were measured continuously during the procedure, and cement penetration was determined by performing sagittal bone cuts. RESULTS Cleansing the femoral bone stock with use of pulsed lavage (Group B) led to increased femoral cement penetration (mean, 1428 mm²; 95% confidence interval, 1348 to 1508 mm²) compared with syringe lavage (Group A) (mean, 1128 mm²; 95% confidence interval, 1038 to 1219 mm²) (p < 0.001). Interface temperature was higher in Group B (mean 22.6°C; 95% confidence interval, 20.5°C to 24.1°C) than in Group A (mean, 21.0°C; 95% confidence interval, 19.4°C to 23.0°C) (p = 0.028), but temperatures never reached critical values for thermal damage to the bone. CONCLUSIONS Pulsed lavage leads to an increased femoral cement penetration without the risk of heat necrosis at the bone-cement interface.
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Affiliation(s)
- J B Seeger
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Giessen, Germany
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Waanders D, Janssen D, Berahmani S, Miller MA, Mann KA, Verdonschot N. Interface micromechanics of transverse sections from retrieved cemented hip reconstructions: an experimental and finite element comparison. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:2023-2035. [PMID: 22678039 PMCID: PMC3400762 DOI: 10.1007/s10856-012-4626-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/17/2012] [Indexed: 06/01/2023]
Abstract
In finite element analysis (FEA) models of cemented hip reconstructions, it is crucial to include the cement-bone interface mechanics. Recently, a micromechanical cohesive model was generated which reproduces the behavior of the cement-bone interface. The goal was to investigate whether this cohesive model was directly applicable on a macro level. From transverse sections of retrieved cemented hip reconstructions, two FEA-models were generated. The cement-bone interface was modeled with cohesive elements. A torque was applied and the cement-bone interface micromotions, global stiffness and stem translation were monitored. A sensitivity analysis was performed to investigate whether the cohesive model could be improved. All results were compared with experimental findings. That the original cohesive model resulted in a too compliant macromechanical response; the motions were too large and the global stiffness too small. When the cohesive model was modified, the match with the experimental response improved considerably.
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Affiliation(s)
- Daan Waanders
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Zhang QH, Tozzi G, Tong J. Micro-mechanical damage of trabecular bone-cement interface under selected loading conditions: a finite element study. Comput Methods Biomech Biomed Engin 2012; 17:230-8. [PMID: 22515517 DOI: 10.1080/10255842.2012.675057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In this study, two micro finite element models of trabecular bone-cement interface developed from high resolution computed tomography (CT) images were loaded under compression and validated using the in situ experimental data. The models were then used under tension and shear to examine the load transfer between the bone and cement and the micro damage development at the bone-cement interface. In addition, one models was further modified to investigate the effect of cement penetration on the bone-cement interfacial behaviour. The simulated results show that the load transfer at the bone-cement interface occurred mainly in the bone cement partially interdigitated region, while the fully interdigitated region seemed to contribute little to the mechanical response. Consequently, cement penetration beyond a certain value would seem to be ineffective in improving the mechanical strength of trabecular bone-cement interface. Under tension and shear loading conditions, more cement failures were found in denser bones, while the cement damage is generally low under compression.
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Affiliation(s)
- Qing-Hang Zhang
- a Mechanical Behaviour of Materials Laboratory, School of Engineering, University of Portsmouth , Anglesea Road, Portsmouth , PO1 3DJ , UK
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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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Martelli S, Taddei F, Schileo E, Cristofolini L, Rushton N, Viceconti M. Biomechanical robustness of a new proximal epiphyseal hip replacement to patient variability and surgical uncertainties: A FE study. Med Eng Phys 2012; 34:161-71. [DOI: 10.1016/j.medengphy.2011.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 06/08/2011] [Accepted: 07/11/2011] [Indexed: 11/27/2022]
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Tozzi G, Zhang QH, Tong J. 3D real-time micromechanical compressive behaviour of bone–cement interface: Experimental and finite element studies. J Biomech 2012; 45:356-63. [DOI: 10.1016/j.jbiomech.2011.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 09/29/2011] [Accepted: 10/07/2011] [Indexed: 11/16/2022]
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Wang JS, Garellick G, Kjellson F, Tanner E, Flivik G. Modified femoral pressuriser generates a longer lasting high pressure during cement pressurisation. J Orthop Surg Res 2011; 6:54. [PMID: 22004662 PMCID: PMC3206458 DOI: 10.1186/1749-799x-6-54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 10/17/2011] [Indexed: 11/10/2022] Open
Abstract
Background The strength of the cement-bone interface in hip arthroplasty is strongly related to cement penetration into the bone. A modified femoral pressuriser has been investigated, designed for closer fitting into the femoral opening to generate higher and more constant cement pressure compared to a commercial (conventional) design. Methods Femoral cementation was performed in 10 Sawbones® models, five using the modified pressuriser and five using a current commercial pressuriser as a control. Pressure during the cementation was recorded at the proximal and distal regions of the femoral implant. The peak pressure and the pressure-time curves were analysed by student's t-test and Two way ANOVA. Results The modified pressuriser showed significantly and substantially longer durations at higher cementation pressures and slightly, although not statistically, higher peak pressures compared to the conventional pressuriser. The modified pressuriser also produced more controlled cement leakage. Conclusion The modified pressuriser generates longer higher pressure durations in the femoral model. This design modification may enhance cement penetration into cancellous bone and could improve femoral cementation.
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Affiliation(s)
- Jian-Sheng Wang
- Department of Orthopedics, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, S-221 85, Sweden.
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Tarala M, Waanders D, Biemond JE, Hannink G, Janssen D, Buma P, Verdonschot N. The effect of bone ingrowth depth on the tensile and shear strength of the implant-bone e-beam produced interface. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:2339-2346. [PMID: 21858722 DOI: 10.1007/s10856-011-4419-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 08/08/2011] [Indexed: 05/31/2023]
Abstract
New technologies, such as selective electron beam melting, allow to create complex interface structures to enhance bone ingrowth in cementless implants. The efficacy of such structures can be tested in animal experiments. Although animal studies provide insight into the biological response of new structures, it remains unclear how ingrowth depth is related to interface strength. Theoretically, there could be a threshold of ingrowth, above which the interface strength does not further increase. To test the relationship between depth and strength we performed a finite element study on micro models with simulated uncoated and hydroxyapatite (HA) coated surfaces. We examined whether complete ingrowth is necessary to obtain a maximal interface strength. An increase in bone ingrowth depth did not always enhance the bone-implant interface strength. For the uncoated specimens a plateau was reached at 1,500 μm of ingrowth depth. For the specimens with a simulated HA coating, a bone ingrowth depth of 500 μm already yielded a substantial interface strength, and deeper ingrowth did not enhance the interface strength considerably. These findings may assist in optimizing interface morphology (its depth) and in judging the effect of bone ingrowth depth on interface strength.
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Affiliation(s)
- M Tarala
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Waanders D, Janssen D, Mann KA, Verdonschot N. Morphology based cohesive zone modeling of the cement-bone interface from postmortem retrievals. J Mech Behav Biomed Mater 2011; 4:1492-503. [PMID: 21783159 DOI: 10.1016/j.jmbbm.2011.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 05/06/2011] [Accepted: 05/07/2011] [Indexed: 11/28/2022]
Abstract
In cemented total hip arthroplasty, the cement-bone interface can be considerably degenerated after less than one year in vivo service; this makes the interface much weaker relative to the direct post-operative situation. It is, however, still unknown how these degenerated interfaces behave under mixed-mode loading and how this is related to the interface morphology. In this study, we used a finite element (FE) approach to analyze the mixed-mode response of the cement-bone interface taken from postmortem retrievals. We investigated whether it was feasible to generate a fully elastic and a failure cohesive model based on only morphological input parameters. Computed tomography-based FE-models of postmortem cement-bone interfaces were generated and the interface morphology was determined. The models were loaded until failure in multiple directions by allowing cracking of the bone and cement components and including periodic boundary conditions. The resulting stiffness was related to the interface morphology. A closed form mixed-mode cohesive model that included failure was determined and related to the interface morphology. The responses of the FE-simulations compare satisfactorily with experimental observations, albeit the magnitude of the strength and stiffness are somewhat overestimated. Surprisingly, the FE-simulations predict no failure under shear loading and a considerable normal compression is generated which prevents dilation of the interface. The obtained mixed-mode stiffness response could subsequently be related to the interface morphology and subsequently be formulated into an elastic cohesive zone model. Finally, the acquired data could be used as an input for a cohesive model that also includes interface failure.
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Affiliation(s)
- Daan Waanders
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Waanders D, Janssen D, Mann KA, Verdonschot N. The behavior of the micro-mechanical cement-bone interface affects the cement failure in total hip replacement. J Biomech 2011; 44:228-34. [PMID: 21036358 PMCID: PMC3019267 DOI: 10.1016/j.jbiomech.2010.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 10/13/2010] [Indexed: 11/30/2022]
Abstract
In the current study, the effects of different ways to implement the complex micro-mechanical behavior of the cement-bone interface on the fatigue failure of the cement mantle were investigated. In an FEA-model of a cemented hip reconstruction the cement-bone interface was modeled and numerically implemented in four different ways: (I) as infinitely stiff, (II) as infinitely strong with a constant stiffness, (III) a mixed-mode failure response with failure in tension and shear, and (IV) realistic mixed mode behavior obtained from micro-FEA models. Case II, III, and IV were analyzed using data from a stiff and a compliant micro-FEA model and their effects on cement failure were analyzed. The data used for Case IV was derived from experimental specimens that were tested previously. Although the total number of cement cracks was low for all cases, the compliant Case II resulted in twice as many cracks as Case I. All cases caused similar stress distributions at the interface. In all cases, the interface did not display interfacial softening; all stayed the elastic zone. Fatigue failure of the cement mantle resulted in a more favorable stress distribution at the cement-bone interface in terms of less tension and lower shear tractions. We conclude that immediate cement-bone interface failure is not likely to occur, but its local compliancy does affect the formation of cement cracks. This means that at a macro-level the cement-bone interface should be modeled as a compliant layer. However, implementation of interfacial post-yield softening does seems to be necessary.
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Affiliation(s)
- Daan Waanders
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Waanders D, Janssen D, Bertoldi K, Mann KA, Verdonschot N. Mixed-mode loading of the cement-bone interface: a finite element study. Comput Methods Biomech Biomed Engin 2010; 14:145-55. [PMID: 21170769 DOI: 10.1080/10255842.2010.535814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While including the cement-bone interface of complete cemented hip reconstructions is crucial to correctly capture their response, its modelling is often overly simplified. In this study, the mechanical mixed-mode response of the cement-bone interface is investigated, taking into account the effects of the well-defined microstructure that characterises the interface. Computed tomography-based plain strain finite element analyses models of the cement-bone interface are built and loaded in multiple directions. Periodic boundaries are considered and the failure of the cement and bone fractions by cracking of the bulk components are included. The results compare favourably with experimental observations. Surprisingly, the analyses reveal that under shear loading no failure occurs and considerable normal compression is generated to prevent interface dilation. Reaction forces, crack patterns and stress fields provide more insight into the mixed-mode failure process. Moreover, the cement-bone interface analyses provide details which can serve as a basis for the development of a cohesive law.
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Affiliation(s)
- Daan Waanders
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Miller MA, Race A, Waanders D, Cleary R, Janssen D, Verdonschot N, Mann KA. Multi-axial loading micromechanics of the cement-bone interface in postmortem retrievals and lab-prepared specimens. J Mech Behav Biomed Mater 2010; 4:366-74. [PMID: 21316624 DOI: 10.1016/j.jmbbm.2010.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/08/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
Maintaining adequate fixation between cement and bone is important for successful long term survival of cemented total joint replacements. Mixed-mode loading conditions (combination of tension/compression and shear) are present during in vivo loading, but the micromotion response of the interface to these conditions is not fully understood. Non-destructive, multi-axial loading experiments were conducted on laboratory prepared (n=6) and postmortem (n=6) human cement-bone interfaces. Specimens were mounted in custom loading discs and loaded at 0°, 30°, 60°, and 90° relative to the interface plane where 0° represents normal loading to the interface, and 90° represents shear loading along the longitudinal axis of the femur. Axial compliance did not depend on loading angle for laboratory prepared (p=0.96) or postmortem specimens (p=0.62). The cement-bone interface was more compliant under tensile than compressive loading at the 0° loading angle only (p=0.024). The coupled transverse to axial compliance ratio, which is a measure of the coupled motion, was small for laboratory prepared (0.115 ± 0.115) and postmortem specimens (0.142 ± 0.101). There was a moderately strong inverse relationship between interface compliance and contact index (r(2)=0.65). From a computational modeling perspective, the results of the current study support the concept that the cement-bone interface could be numerically implemented as a compliant layer with the same initial stiffness in tension and shear directions. The magnitude of the compliance could be modified to simulate immediate post-operative conditions (using laboratory prepared data set) or long-term remodeling (using postmortem data set).
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Waanders D, Janssen D, Mann KA, Verdonschot N. The effect of cement creep and cement fatigue damage on the micromechanics of the cement-bone interface. J Biomech 2010; 43:3028-34. [PMID: 20692663 DOI: 10.1016/j.jbiomech.2010.06.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 06/29/2010] [Accepted: 06/30/2010] [Indexed: 11/28/2022]
Abstract
The cement-bone interface provides fixation for the cement mantle within the bone. The cement-bone interface is affected by fatigue loading in terms of fatigue damage or microcracks and creep, both mostly in the cement. This study investigates how fatigue damage and cement creep separately affect the mechanical response of the cement-bone interface at various load levels in terms of plastic displacement and crack formation. Two FEA models were created, which were based on micro-computed tomography data of two physical cement-bone interface specimens. These models were subjected to tensile fatigue loads with four different magnitudes. Three deformation modes of the cement were considered: 'only creep', 'only damage' or 'creep and damage'. The interfacial plastic deformation, the crack reduction as a result of creep and the interfacial stresses in the bone were monitored. The results demonstrate that, although some models failed early, the majority of plastic displacement was caused by fatigue damage, rather than cement creep. However, cement creep does decrease the crack formation in the cement up to 20%. Finally, while cement creep hardly influences the stress levels in the bone, fatigue damage of the cement considerably increases the stress levels in the bone. We conclude that at low load levels the plastic displacement is mainly caused by creep. At moderate to high load levels, however, the plastic displacement is dominated by fatigue damage and is hardly affected by creep, although creep reduced the number of cracks in moderate to high load region.
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Affiliation(s)
- Daan Waanders
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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