- See:
Total Hip Replacement Menu:
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cementless components:
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cement technique
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acetabular component revision:
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operative considerations for hip dyplasia
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protrusio
- Discussion:
- technical considerations:
- in the report by BM Crites et al (CORR 2000), the effect of porosity reduction
cementing techniques with respect to radiolucent lines in Zone 1 and failure in acetabular components was studied
in 2237 consecutive cemented acetabular components done between 1970 and 1998.
- porosity reduction techniques did not reduce the incidence of Zone 1 radiolucencies;
- factors that were considered essential included:
- reaming through the subchondral bone to achieve a good cancellous bone bed;
- perforation and removal of peripheral sclerotic areas;
- dry cancellous bone bed
- pressurization of the entire cement mantle in the socket at one time;
- complete burying of the acetabular component within the boundary of the bony acetabulum;
- ref: Technical Considerations of Cemented Acetabular Components A 30-Year Eval BM. Crites COOR 2000 December;2000(381):114-119
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special situations:
- cement resurfacing for fracture:
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Secondary total hip replacement after fractures of the femoral neck.
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Bone impaction grafting and a cemented cup after acetabular fracture at 3-18 years.
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The chronic central fracture dislocation of the hip
- impaction grafting:
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Reconstruction of acetabular defect with wire mesh and impacted bonegraft in cemented acetabular revision
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Acetabular Reconstruction with Impaction Bone-Grafting and a Cemented Cup in Patients Younger Than Fifty Years Old.
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Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with RA: 3-14-year follow-up.
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Acetabular revision with morsellised allogenic bone graft and a cemented metal-backed component.
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Acetabular reconstruction with impacted bone allografts and cemented acetabular components: a 2-13-yr f/u of 142 aseptic revisions.
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Acetabular reconstruction w/ impacted morsellised cancellous bone graft and cement. A 10-15-yr f/u of 60 revision arthroplasties.
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Particle size of bone graft and method of impaction affect initial stability of cemented cups: human cadaveric and synthetic pelvic specimen studies.
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Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup. A 15- to 20-year follow-up.
- Technique:
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acetabular exposure,
estabilishment of acetabular floor, and
reaming are carried out in the usual manner;
- need to ream through the subchondral bone to achieve a good cancellous bone bed;
- perforation and removal of peripheral sclerotic areas;
- references:
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Is removal of subchondral bone plate advantageous in cemented cup fixation? A randomized RSA study
- drill holes:
- multiple (five to eight)
5-mm-diameter countersink holes were placed throughout the acetabulum;
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Fixation of the acetabular cup in cemented THR: improving the anchorage hole profile using finite element method.
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Optimizing the configuration of cement keyholes for acetabular fixation in THR using Taguchi experimental design.
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Configuration of anchorage holes affects cemented fixation of the acetabular component in THR - An in vitro study.
- bone grafting for acetabular defects;
- cancellous bone chips with a diameter
of 0.7 to 1.0 cm were created
- segmental defects in
the medial wall or peripheral defects of the acetabulum are
closed with a slice of corticocancellous bone or with metal
mesh;
- a trial acetabular prosthesis (w/ mallet) are impacted against the bone grafts.
- need to restore the original center of rotation of the
hip, (use transverse ligament as a reference);
- consider directly cementing the graft at the reconstruction site;
- references:
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Particle size of bone graft and method of impaction affect initial stability of cemented cups: human cadaveric and synthetic pelvic specimen studies.
- cement technique:
- achieve a dry cancellous bone bed (hypotensive anesthesia);
- pressurization of the entire cement mantle in the socket at one time;
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Acetabular cement compactor. An experimental study of pressurization of cement in the acetabulum in THA
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In Vitro Pressurization of the Acetabular Cement Mantle. The Effect of a Flange
- complications:
- note that exothermic reaction (and ensuing heat) that occurs during cement hardening may injure soft tissue structures opposite of acetabulum (especially
when the acetabulum is thin);
- component loosening:
- patients may or may not show symptoms from cemented cup loosening;
- radiographic demarcation of the bone cement interface on immediate postoperative x-rays is a strong risk factor for early component loosening;
- as noted by Garcia-Cimbrello et al 1997, 13 of 18 cups with a complete radiolucent line on initial radiographs migrated;
- as noted by Kavanaugh and Fitzgerald 1987, 70% of cemented acetabular revisions developed progressive radiolucencies;
- these authors noted a 10% failure rate at 2 years;
- references:
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The mechanism of loosening of cemented acetabular components in total hip arthroplasty. Analysis of specimens retrieved at autopsy.
- Progression of radiolucent lines adjacent to acetabular component and factors influencing migration after Charnley low friction THA.
E Garcia-Cimbrelo MD et al. JBJS Vol 79-A. No 9. Sep 1997. p 1373.
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Failure of the Mecring screw-ring acetabular component in total hip arthroplasty. A three to seven-year follow-up study.
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Loosening of the cemented hip prosthesis. The importance of heat injury.
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Early migration of acetabular components revised with cement. A roentgen stereophotogrammetric study.
Current status of acetabular fixation in primary total hip arthroplasty.
The role of cemented sockets in 2004: is there one?
Fixation of the acetabular component. The case for cement
Primary total hip arthroplasty with a flanged, cemented all-polyethylene acetabular component: evaluation at a minimum of 20 years.
Cemented cup revisions.
Acetabular reconstruction with bone impaction grafting and a cemented cup: 20 years' experience.
Total Hip Arthroplasty with Cement and Use of a Collared Matte-Finish Femoral Component
Multiple revision for failed total hip arthroplasty not associated with infection. Kavanaugh, BK and Ritzgerald, RH. JBJS. Vol 69-A. 1987. p 1144-1149.
