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Cementing techniques in hip resurfacing

Cementing techniques in hip resurfacing
Cementing techniques in hip resurfacing
The subject of the cementing technique in hip resurfacing has been poorly studied to date. The hip resurfacing prosthesis is unique in the family of cemented prostheses because the cement mantle is blind (hidden underneath the implant) and is radiographically obscured. This presents an immediate challenge to the surgeon at the time of surgery, but also has a longer-term implication in terms of lack of post-operative clinical observation. This should be compared with total hip replacement or total knee replacement where the cement mantle can at least be partially observed both intra- and post-operatively. With this in mind, the objective of this review is, firstly, to understand the cement mantles typically achieved in current clinical practice and, secondly, to identify those factors affecting the cement mantle and to consolidate them into an improved and reproducible cementing technique. The outcome of this work shows that the low-viscosity technique can commonly lead to excessive cement penetration in the proximal femoral head and an incompletely seated component, whereas a more consistent controlled cement mantle can be achieved with a high-viscosity cementing technique. Consequently, it is recommended that a high-viscosity technique should be used to minimize the build-up of excessive cement, to reduce the temperature created by the exothermic polymerization, and to help to ensure correct seating of the prosthesis. A combination of these factors is potentially critical to the clinical success of some articular surface replacement (ASR) procedures. It is important to note that we specifically studied the DePuy ASR system; therefore only the general principles (and not the specifics) of the cementing technique may apply to other resurfacing prostheses, because of differences in internal geometry, clearance, and surgical technique.
bone cement, cementing technique, hip resurfacing
0954-4119
321-331
Chandler, M.
6ed1e7d3-08c4-4d1a-bc8c-500108fa60e7
Kowalski, R.S.Z.
851d03da-8e15-48d1-ac4e-acd773bbaee5
Watkins, N.D.
717a7e99-9d0d-4e9b-bf41-bc024b53e0a9
Briscoe, A.
bce18fc7-3031-4acc-b570-da949accccd4
New, A.M.R.
d2fbaf80-3abd-4bc5-ae36-9c77dfdde0d6
Chandler, M.
6ed1e7d3-08c4-4d1a-bc8c-500108fa60e7
Kowalski, R.S.Z.
851d03da-8e15-48d1-ac4e-acd773bbaee5
Watkins, N.D.
717a7e99-9d0d-4e9b-bf41-bc024b53e0a9
Briscoe, A.
bce18fc7-3031-4acc-b570-da949accccd4
New, A.M.R.
d2fbaf80-3abd-4bc5-ae36-9c77dfdde0d6

Chandler, M., Kowalski, R.S.Z., Watkins, N.D., Briscoe, A. and New, A.M.R. (2006) Cementing techniques in hip resurfacing. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 220 (2), 321-331. (doi:10.1243/09544119JEIM113).

Record type: Article

Abstract

The subject of the cementing technique in hip resurfacing has been poorly studied to date. The hip resurfacing prosthesis is unique in the family of cemented prostheses because the cement mantle is blind (hidden underneath the implant) and is radiographically obscured. This presents an immediate challenge to the surgeon at the time of surgery, but also has a longer-term implication in terms of lack of post-operative clinical observation. This should be compared with total hip replacement or total knee replacement where the cement mantle can at least be partially observed both intra- and post-operatively. With this in mind, the objective of this review is, firstly, to understand the cement mantles typically achieved in current clinical practice and, secondly, to identify those factors affecting the cement mantle and to consolidate them into an improved and reproducible cementing technique. The outcome of this work shows that the low-viscosity technique can commonly lead to excessive cement penetration in the proximal femoral head and an incompletely seated component, whereas a more consistent controlled cement mantle can be achieved with a high-viscosity cementing technique. Consequently, it is recommended that a high-viscosity technique should be used to minimize the build-up of excessive cement, to reduce the temperature created by the exothermic polymerization, and to help to ensure correct seating of the prosthesis. A combination of these factors is potentially critical to the clinical success of some articular surface replacement (ASR) procedures. It is important to note that we specifically studied the DePuy ASR system; therefore only the general principles (and not the specifics) of the cementing technique may apply to other resurfacing prostheses, because of differences in internal geometry, clearance, and surgical technique.

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Published date: February 2006
Additional Information: Special issue paper
Keywords: bone cement, cementing technique, hip resurfacing

Identifiers

Local EPrints ID: 30133
URI: http://eprints.soton.ac.uk/id/eprint/30133
ISSN: 0954-4119
PURE UUID: e7106afe-9e06-4c57-a4df-a81f3cd17dbe

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Date deposited: 10 May 2006
Last modified: 15 Mar 2024 07:37

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Contributors

Author: M. Chandler
Author: R.S.Z. Kowalski
Author: N.D. Watkins
Author: A. Briscoe
Author: A.M.R. New

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