Failure analysis of the cement mantle in total hip arthroplasty with an efficient probabilistic method

Introduction: We investigated the in vivo gentamicin elution kinetics of Hi-Fatigue Gentamicin Bone Cement (AAP Biomaterials GmbH) in serum and drain fluid after hybrid hip arthroplasty and the relationship with cement mantle thickness. Methods: We compared in a randomised, non-blinded prospective study, the local and systemic gentamicin concentrations in 2 groups. The thin cement mantle group ( n = 16) received a stem implanted line-to-line with the broach, whereas the thick group ( n = 14) had an undersized stem. Gentamicin concentrations were measured in drain fluid and serum at set intervals for 3 days postoperatively. Results: In both groups, local gentamicin concentrations were similar. After a high initial burst above the minimal inhibitory concentration (thin: 57.2 mg/L (SD 34.4), thick: 54.9 mg/L (SD 19.9), p = 0.823) local gentamicin concentrations declined rapidly. In both groups, serum concentrations never exceeded toxic levels (maximum 1.08 mg/L). Conclusion: In hybrid total hip arthroplasty, Hi-Fatigue Gentamicin Bone Cement resulted in effective and safe gentamicin concentrations. Clinical trial protocol number: PMCI 12/02.

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The Effect of Surgical Technique on Cement Mantle Strength in Total Hip Arthroplasty

Hip International ◽

10.1177/1120700095005003-402 ◽

1995 ◽

Vol 5 (3-4) ◽

pp. 102-107

Author(s):

J. M. Webb ◽

A. J. Mahajan ◽

G. C. Bannister ◽

R. C. Haynes ◽

A. W. Miles

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Cement Mantle ◽

Unit Weight ◽

Total Hip ◽

Cement Strength ◽

Retrograde Technique ◽

Mantle Thickness ◽

Cement Restrictor ◽

Cementing Techniques

A tapered aluminium model was designed to simulate the internal geometry of the reamed femoral medullary cavity. The surface of the model was coated with blood and then polymethylmethacrylate cement (Simplex P, Howmedica UK) was inserted retrograde, prograde, prograde with a venting tube, prograde with a perforated distal cement restrictor, all with a cement gun; and manually by thumbing with a venting tube. Casts were examined radiographically, weighed, measured and tested to failure in compression. Using the same cementing techniques, both concentric and eccentric mantles were produced by insertion of a prosthesis, with or without spacers, and tested to failure in hoop tension. Cast weight correlated with cement strength per unit weight and volume. Casts produced by the retrograde technique were heaviest and those produced by prograde with a venting and thumbed mantles the weakest. Concentric mantles were stronger than eccentric. Incomplete spacers ensured concentricity but weakened the mantle such that no benefit was gained. Complete precast spacers also ensured concentricity and a minimum mantle thickness but did not compromise mantle strength. The best method of inserting cement in the femur during total hip arthroplasty is retrograde with a complete precast spacer.

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Optimizing the Femoral Component Cement Mantle in Total Hip Arthroplasty

Orthopedics ◽

10.3928/0147-7447-20050802-13 ◽

2005 ◽

Vol 28 (8) ◽

pp. 867-871 ◽

Cited By ~ 2

Author(s):

Douglas A Dennis ◽

Christopher B Lynch

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Component ◽

Hip Arthroplasty ◽

Cement Mantle ◽

Total Hip

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Radiographic evaluation of mechanically tested cemented total hip arthroplasty femoral components retrieved post-mortem

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632816 ◽

2004 ◽

Vol 17 (04) ◽

pp. 216-224 ◽

Cited By ~ 4

Author(s):

E. Pluhar ◽

C. P. Skurla ◽

E. L. Egger ◽

S. P. James ◽

D. J. Frankel

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Effective Means ◽

Cement Mantle ◽

Radiographic Evaluation ◽

Post Mortem ◽

Implant Loosening ◽

Implant Stability ◽

Radiographic Findings ◽

Total Hip

SummaryGuidelines for assessing total hip arthroplasty (THA) radiographs for femoral implant stability have not been published; therefore, often the determination is subjective. The aim of this study was to identify radiographic criteria for veterinary clinicians to use when evaluating radiographs for femoral implant stability. Specific objectives were to: identify radiographic features associated with canine THA femoral implant loosening, evaluate whether technical recommendations for human femoral component implantation apply to dogs, and evaluate the effectiveness of radiographs for identifying canine THA implant loosening. Post-operative, follow-up, and post-mortem contact radiographs of canine implanted femora retrieved postmortem and mechanically tested for implant stability were evaluated. Based on the results, radiographic evaluation is not an effective means of assessing canine femoral implant stability; however, certain radiographic findings including implant retroversion, cement mantle cracks, or the appearance of cementmetal interface radiolucencies, may be indicative of implant loosening. It was also found that femoral implants completely surrounded by cement mantle of any thickness were less likely to loosen than those with an area lacking cement between the implant and bone. There was also a trend suggesting an association between inferior cement mantle quality and femoral implant loosening. In order to improve cement mantle quality and ensure that implants are completely surrounded by cement mantle, the use of modern cementing techniques is recommended.

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