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Cementing Techniques for Hip Resurfacing Arthroplasty: Development of a Laboratory Model

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{at}earthlink.net

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.

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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