In vitro long-term fatigue endurance of the secondary "Cement Injection Stem" hip prosthesis.

A secondary cementation hip stem (Cement Injection Stem; Aesculap, Tuttlingen, Germany) was designed to reduce the risk of fat embolism, and achieve precise implant position and high-quality cement mantle. A validated long-term in vitro simulation was carried out that replicated 24 years of activity of a very demanding patient. Inducible and permanent micromotions were monitored. The cement mantle was sectioned and inspected for signs of fatigue damage. The stem-cement interface was inspected for fretting. Results were compared against previously published results for a conventionally implanted stem with comparable design (Centrament; Aesculap) from which this project was derived. Comparable micromotions were found (slightly larger proximally, in correspondence to the precured centralizer). No sign of fretting was observed. All fatigue damage indicators were comparable or significantly better than those for the conventionally implanted stem. The few cement cracks found were mainly localized in proximity of a proximal drainage hole. It is foreseen that when this detail is optimized, long-term endurance will further improve.

[1]  W J Maloney,et al.  The initiation of failure in cemented femoral components of hip arthroplasties. , 1991, The Journal of bone and joint surgery. British volume.

[2]  J. Healey,et al.  Cardiac arrest during hip arthroplasty with a cemented long-stem component. A report of seven cases. , 1991, The Journal of bone and joint surgery. American volume.

[3]  A Sarmiento,et al.  The cement mantle in total hip arthroplasty. Analysis of long-term radiographic results. , 1994, The Journal of bone and joint surgery. American volume.

[4]  A Rohlmann,et al.  Is staircase walking a risk for the fixation of hip implants? , 1995, Journal of biomechanics.

[5]  L Cristofolini,et al.  Initial stability of uncemented hip stems: an in-vitro protocol to measure torsional interface motion. , 1995, Medical engineering & physics.

[6]  L Cristofolini,et al.  Mechanical validation of whole bone composite femur models. , 1996, Journal of biomechanics.

[7]  N Verdonschot,et al.  Cement Debonding Process of Total Hip Arthroplasty Stems , 1997, Clinical orthopaedics and related research.

[8]  L. Ryd,et al.  Effects of lamination on the strength of bone cement. , 1997, Acta orthopaedica Scandinavica.

[9]  L Cristofolini,et al.  A critical analysis of stress shielding evaluation of hip prostheses. , 1997, Critical reviews in biomedical engineering.

[10]  Klaus Draenert,et al.  Prophylaxis of Fat and Bone Marrow Embolism in Cemented Total Hip Arthroplasty , 1998 .

[11]  R P Pitto,et al.  Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during total hip arthroplasty. A prospective, randomized clinical trial. , 1999, The Journal of bone and joint surgery. American volume.

[12]  S. Maher,et al.  Quantification of interdigitation at bone cement/cancellous bone interfaces in cemented femoral reconstructions , 1999, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[13]  L Cristofolini,et al.  Methods for quantitative analysis of the primary stability in uncemented hip prostheses. , 1999, Artificial organs.

[14]  R E Jones,et al.  Comparative micromotion of fully and proximally cemented femoral stems. , 1999, Clinical orthopaedics and related research.

[15]  J. Kabo,et al.  Influence of Cement Technique on the Interface Strength of Femoral Components , 2000, Clinical orthopaedics and related research.

[16]  A. Cappello,et al.  Mechanical validation of whole bone composite tibia models. , 2000, Journal of biomechanics.

[17]  L Cristofolini,et al.  A CAD-CAM methodology to produce bone-remodelled composite femurs for preclinical investigations , 2001, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[18]  M Honl,et al.  Duration and frequency of every day activities in total hip patients. , 2001, Journal of biomechanics.

[19]  G. Bergmann,et al.  Hip contact forces and gait patterns from routine activities. , 2001, Journal of biomechanics.

[20]  S Stea,et al.  Registration of hip prostheses at the Rizzoli institute: 11 years' experience , 2002, Acta orthopaedica Scandinavica. Supplementum.

[21]  Frederick J Dorey,et al.  The need to account for patient activity when evaluating the results of total hip arthroplasty with survivorship analysis. , 2002, The Journal of bone and joint surgery. American volume.

[22]  P J Prendergast,et al.  Discriminating the loosening behaviour of cemented hip prostheses using measurements of migration and inducible displacement. , 2002, Journal of biomechanics.

[23]  R. Huiskes,et al.  Stair Climbing is More Detrimental to the Cement in Hip Replacement than Walking , 2002, Clinical orthopaedics and related research.

[24]  Angelo Cappello,et al.  Comparative in vitro study on the long term performance of cemented hip stems: validation of a protocol to discriminate between "good" and "bad" designs. , 2003, Journal of biomechanics.

[25]  V. Harder,et al.  Early failure of a proximally cemented, distally uncemented total hip arthroplasty. , 2003, The Journal of arthroplasty.

[26]  V. Jansson,et al.  Stress transfer at the femoral bone/bone cement interface as a function of the cement thickness , 2004, Archives of Orthopaedic and Trauma Surgery.

[27]  R. Bloebaum,et al.  Analysis of 16 retrieved proximally cemented femoral stems. , 2005, The Journal of arthroplasty.

[28]  Patrick J Prendergast,et al.  Preclinical testing of femoral hip components: an experimental investigation with four prostheses. , 2005, Journal of biomechanical engineering.

[29]  L. Cristofolini,et al.  Analysis of 16 retrieved proximal cemented femoral stems. , 2006, The Journal of arthroplasty.

[30]  Marco Viceconti,et al.  Partially cemented AncaDualFit hip stems do not fail in simulated active patients. , 2007, Clinical biomechanics.