Getting it Right by Analyzing Failures and Biomechanical Models   |    
Cementing Techniques for Hip Resurfacing Arthroplasty: Development of a Laboratory Model
Rudi G. Bitsch, MD1; Travis Loidolt, BA2; Christian Heisel, MD1; Thomas P. Schmalzried, MD2
1 Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200A, 69118 Heidelberg, Germany
2 Joint Replacement Institute, 2200 West Third Street, Suite, Los Angeles, CA 90057. E-mail address for T.P. Schmalzried: schmalzried@earthlink.net
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Stiftung Orthopädische Universitätsklinik Heidelberg and less than $10,000 from the Piedmont Fund of the Los Angeles Orthopaedic Hospital Foundation. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DePuy). Also, a commercial entity (DePuy) paid or directed in any one year, or agreed to pay or direct, benefits of less than $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Aug 01;90(Supplement 3):102-110. doi: 10.2106/JBJS.H.00622
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Background: Hip resurfacing is extremely technique-sensitive, yet scientific investigations into cementing techniques are lacking. In this study, we tested open-cell, reticulated, carbon-foam materials in comparison with paired human femoral heads to validate a laboratory cementing model for resurfacing arthroplasty.

Methods: Paired human femoral heads prepared for resurfacing were compared with thirty and sixty-pore-per-inch fat-filled foam specimens. Two different cementing techniques were analyzed: manual application of high-viscosity cement, and half component-filling with low-viscosity cement. Real-time measurements were made of cement pressure and temperature. Cement penetration areas and depths were quantified.

Results: We found no significant differences between the human femoral heads and the fat-filled thirty-pore-per-inch foam models in all measured variables (pressures at the top, chamfer and outer wall, temperature at the 5-mm and 15-mm subsurface). There was no significant difference in the cement penetration of the human femoral heads and the fat-filled thirty-pore-per-inch foam models. There were a number of significant differences between the human femoral heads and the sixty-pore-per-inch foam models with use of the low-viscosity cement technique. The differences between the cementing techniques were greater than those between the three materials for most of the measurements.

Conclusions: Fat-filling (to emulate bone marrow) of lower-density carbon foam more closely simulates the cement penetration resistance and thermal properties of human femoral heads than does the denser (unfilled) material. This model is sensitive to differences in cementing technique.

Clinical Relevance: Investigations of different cementing techniques with use of a standardized laboratory model may provide information to improve cementing technique in hip-resurfacing surgery.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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