Effect of long-term physiological activity on the long-term stem stability of cemented hip arthroplasty

In vitro comparison of three commercial bone cements

E. Bialoblocka-Juszczyk, L. Cristofolini, P. Erani, M. Viceconti

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Long-term endurance of the cement mantle is fundamental for the survival of cemented hip prostheses. Current protocols to characterize bone cements are unsuitable to predict the actual clinical outcome. The aim of this study was to assess if it is possible to rank cement types having diverse clinical outcome by using a simplified in vitro physiological test. Composite femurs were implanted with identical stems (Lubinus-SPII), using different commercial cement types: CMW1 to represent cement with poor clinical outcome; Simplex-P and Cemex-RX to represent cements with a positive clinical outcome. Implanted femurs were subjected to a validated protocol that simulated a demanding but physiological loading spectrum. Inducible micromotions and permanent migrations were recorded throughout the test. After test completion, the cement mantles were sectioned and inspected with dye penetrants to quantify the fatigue-induced cracks. Micromotions did not differ significantly between cement types (possibly because a successful prosthesis was chosen that is very stable in the host bone). Significant differences were observed in terms of cement cracks: CMW1 induced significantly more numerous and larger cracks than Simplex-P and Cemex-RX; no difference was observed between Simplex-P and Cemex-RX. This indicates that this protocol: (a) can discriminate between 'good' and 'bad' cements and (b) yields consistent results when comparable cements are tested. The proposed protocol overcomes the limitations of existing standardized material tests for bone cements. New cements can be assessed in comparison with other cements with known (positive/negative) clinical outcome, tested with the same protocol.

Original languageEnglish
Pages (from-to)53-65
Number of pages13
JournalProceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine
Volume224
Issue number1
DOIs
Publication statusPublished - Jan 1 2010

Fingerprint

Methylmethacrylate
Arthroplasty
Bone cement
Bone Cements
Hip
Cements
Femur
Hip Prosthesis
Prostheses and Implants
Fatigue
Coloring Agents
Bone and Bones
Cracks
In Vitro Techniques
Hip prostheses
Bone
Durability
Dyes
Fatigue of materials

Keywords

  • Cemented hip prostheses acrylic bone cement long-term stability fatigue testing physiological loading pre-clinical validation aseptic loosening of the stem

ASJC Scopus subject areas

  • Mechanical Engineering
  • Medicine(all)

Cite this

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abstract = "Long-term endurance of the cement mantle is fundamental for the survival of cemented hip prostheses. Current protocols to characterize bone cements are unsuitable to predict the actual clinical outcome. The aim of this study was to assess if it is possible to rank cement types having diverse clinical outcome by using a simplified in vitro physiological test. Composite femurs were implanted with identical stems (Lubinus-SPII), using different commercial cement types: CMW1 to represent cement with poor clinical outcome; Simplex-P and Cemex-RX to represent cements with a positive clinical outcome. Implanted femurs were subjected to a validated protocol that simulated a demanding but physiological loading spectrum. Inducible micromotions and permanent migrations were recorded throughout the test. After test completion, the cement mantles were sectioned and inspected with dye penetrants to quantify the fatigue-induced cracks. Micromotions did not differ significantly between cement types (possibly because a successful prosthesis was chosen that is very stable in the host bone). Significant differences were observed in terms of cement cracks: CMW1 induced significantly more numerous and larger cracks than Simplex-P and Cemex-RX; no difference was observed between Simplex-P and Cemex-RX. This indicates that this protocol: (a) can discriminate between 'good' and 'bad' cements and (b) yields consistent results when comparable cements are tested. The proposed protocol overcomes the limitations of existing standardized material tests for bone cements. New cements can be assessed in comparison with other cements with known (positive/negative) clinical outcome, tested with the same protocol.",
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