The objective of this study was to measure the medullary pressures generated during bone cement injection, pressurization and femoral prosthesis insertion. The measurements were recorded throughout the length of an in vitro femoral model while implanting a series of prosthetic hip stems using different pressurization techniques. The prostheses used were a Charnley 40 flanged stem (Johnson & Johnson DePuy International Limited), an Exeter No. 3 stem (Stryker Howmedica Osteonics, Howmedica International Limited), and a customized femoral component (Johnson & Johnson DePuy International Limited). The following parameters were derived from the pressure data recorded: peak pressure, decay pressure and duration above optimum pressure of 76 kPa to predict adequate penetration.
The custom and Exeter stems generated cement pressures throughout the length of the cavity model that were predicted to achieve adequate bone cement interdigitation into cancellous bone. For all the conditions investigated in this study, when using the Charnley femoral component, an adequate level of cement pressurization was generated in the medial-distal portion of the femoral cavity. It is postulated that this could result in reduced integration of the cement mantle with bone and less effective transmission of functional loads applied during a patient's normal activity, postoperatively.
EbramzadehE.SarmientoA.McKellopH.LlinasA.GoganW.The cement mantle in total hip arthroplasty. Analysis of long-term radiographic results. J. Bone Jt Surg. (Am.), 1994, 76, 77–87.
2.
BeckenbaughR. D.IlstrupD. M.Total hip arthroplasty. A review of three hundred and thirty three cases with long follow-up. J. Bone Jt. Surg. (Am.), 1978, 609, 306–313.
3.
IndongO. H.CarlsonC. E.TomfordW. W.HarrisW. H.Improved fixation of the femoral component after total hip replacement using a methacrylate intramedullary plug. J. Bone Jt Surg. (Am.), 1978, 60, 600–613.
4.
HarrisW. H.McCarthyJ. C.O'NeillD. A.Femoral component loosening using contemporary techniques of femoral cement fixation. J. Bone Jt Surg. (Am., 1982, 64, 1063–1067.
5.
HarrisW. H.McGannW. A.Loosening of the femoral component after the use of the medullary-plug cementing technique. Follow-up note with a minimum of five year follow-up. J. Bone Jt Surg. (Am.), 1986, 68, 1064–1066.
6.
BrittonA. R.MurrayD. W.BulstrodeC. J.McPhersonK.DenhamR. A.A long term comparison of Charnley and Stanmore design total hip replacements. J. Bone Jt. Surg. (Br.), 1996, 78, 802–808.
7.
RobertsD. W.PossR.KellyP.Radiographic comparison of cementing techniques in total hip arthroplasty. J. Arthroplasty, 1986, 1, 241–247.
8.
RussottiG. M.CoventryM. B.StaufferR. N.Cemented total hip arthroplasty with contemporary techniques. A five year follow-up study. Clin. Orthop.1988, 235, 141–147.
9.
MulroyR. D.HarrisW. H.The effect of improved cementing techniques on component loosening in total hip replacement. An 11 year radiographic review. J. Bone Jt Surg. (Br.), 1990, 72, 757–760.
10.
BarrackR. L.MulroyR. D.HarrisW. H.Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. J. Bone Jt Surg. (Am.), 1992, 74 (3), 385–389.
11.
SchmalzriedT. P.HarrisW. H.Hybrid total hip arthroplasty. J. Bone Jt Surg. (Br.), 1993, 75, 608–615.
12.
BallardW. T.CallaghanJ. J.SullivanP. M.JohnstonR. C.The results of improved cementing techniques for total hip arthroplasty in patients less than fifty years old. J. Bone Jt Surg. (Am.). 1994, 76, 995–964.
13.
OishiC. S.WalkerR. H.ColwellC. W.The femoral component in total hip arthroplasty. J. Bone Jt Surg. (Am.), 1994, 76, 1130–1136.
14.
BreuschS. J.DraenerK.Vacuum application of bone cement in total hip arthroplasty. Hip Int., 1997, 7 (4), 1–16.
15.
MalchauH.HerbertsP. Prognosis of total hip replacement in Sweden: Revision and re-revision in THR. In 65th Annual Meeting of the American A. of Orthopaedic Surgeons, New Orleans, 19–23 February 1998, p. 198.
16.
MalchauH.HerbertsP.AhnfeldtI.Prognosis of total hip replacement in Sweden. Follow-up of 92, 675 operations performed 1978 1990. Acta Orthopaedica Scand., 1993, 64, 497–506.
17.
MalchauH.HerbertsP.Prognosis of total hip replacement. Scientific Exhibit at the 63rd Annual Meeting of the American Academy of Orthopaedic Surgeons, February 1996, Altanta, GA, USA.
18.
HalawaM.LeeA. J. C.LingR. S.M.VangalaS. SThe shear strength of trabecular bone from the femur, and some factors affecting the shear strength of the cement-bone interface. Arch. Orthop. Trauma Surg., 1978, 92. 19–30.
19.
KrauseW.KrugW.MillerJ. E.Strength of the cement-bone interface. Clin. Orthop., 1982, 163, 290–299.
20.
PanjabiM. M.CiminoW. R.DrinkerH.Effect of pressure on bone cement stiffness. Acta. Orthopaedica Scand., 1986, 57, 106–110.
21.
MacDonaldW.SwartsE.BeaverR.Penetration and shear strength of cement-bone interfaces in vivo. Clin. Orthop., 1993, 286, 283–288.
22.
MannK. A.AyersD. C.WernerF. W.NicolettaR. J.FortinoM. D.Tensile strength of cement-bone interface depends on the amount of bone interdigitated with PMMA cement. J. Biomechanics, 1997, 30 (4), 339–346.
23.
MarklofK. L.AmstutzH. C.Penetration and flow of acrylic bone cement. Clin. Orthop. Related Res., 1976, 121, 99–102.
24.
LeeA. J.C.LingR. S. M.Improved cementing techniques. American Academy of Orthopaedic Surgeons Instrument Course Lecture.1981, 30, 407–413.
25.
NobleP. C.EspleyA. J.Examination of the influence of surgical technique upon the adequacy of cement fixation in the femur. J. Bone Jt Surg. (Br.), 1982, 64, 120–121.
26.
AskewM. J.SteegeJ. W.LewisJ. L.RanieriJ. R.WixsonR. L.Effect of cement pressure and bone strength polymethyl methacrylate fixation. J. Orthop. Res., 1984, 1 (4), 412–420.
27.
BannisterG. C.MilesA. W.The influence of cementing technique and blood on the strength of the bone-cement interface. Engng in Medicine, 1988, 17, 131–133.
28.
JuiliussonR.RydL. Pressure cementation in the human arthritic hip. In First Meeting of the European Orthopaedic Research Society, Bologna, Italy, 1992, p. 75.
29.
KrauseW.BondyR.MillerJ. E. Sustained pressuriz-ation of acrylic cement in the proximal femur during arthroplasty. In the 27th Annual Meeting of the Orthopaedic Research Society, Nevada, 1981, p. 363.
30.
McCaskieA. M.HarperW. M.BarnesM.GreegP. J. Determination of pressures at the cement-bone interface in the human medullary canal during arthroplasty. In First Meeting of the European Orthopaedic Research Society, Bologna, Italy, 1992, p. 62.
31.
YongS.GoodmanS.JaffeR.An in vitro study of femoral intramedullary pressures during hip replacement using modern cement technique. Clin. Orthop. Related Res., 1994, 302. 297–304.
TronzoR.KallosiT.WycheM.Elevation of inter-medullary pressure when methylmethacrylate is inserted in total hip arthroplasty. J. Bone Jt Surg. (Am.), 1974, 56 (4), 714–718.
34.
MarklofK. L.AmstutzH. C.In vitro measurement of bone-acrylic interface during femoral component insertion. Clin. Orthop. Related Res., 1976, 121, 60–66.
35.
OhI.CarlsonC. E.TomfordW. W.HarrisW. H.Improved fixation of the femoral component after total hip replacement using an intermedullary plug. J. Bone Jt Surg. (Am.), 1978, 60 (A). 608–613.
36.
BourneR. B.AitkenG. K.FinlayJ. B.AndracaP. R. Femoral cement pressurisation in vitro: The effect of intermedullary plugs. In 31st Annual Meeting of the Orthopaedic Research Society, Nevada, 1985. p. 224.
37.
BenjaminJ. B.GieG. A.LeeA. J. C.LingR. S.M.VolzR. G.Cementing technique and the effects of bleeding. J. Bone Jt Surg. (Br.), 1987, 69 (4). 620–624.
38.
ShelleyP.WroblewskiB. M.Socket design and cement pressurisation in the Charnley low-friction arthroplasty. J. Bone Jt Surg. (Am.), 1988, 70 (4), 358–363.
39.
MajkowskiR. S.BannisterG. C.MilesA. W.The effect of bleeding on cement-bone interface. An experimental study. Clin. Orthop. Related Res., 1994, 299, 293–297.
40.
WalkerP. S.SoudryM.EwaldF. C.Control of cement penetration in total knee arthroplasty, Clin. Orthop. Related Res., 1984, 185, 155–164.
41.
NobleP. C.SwartsE.The penetration of acrylic cement in cancellous bone. Acta Orthopaedica Scand., 1983, 54, 566–573.
