Fixation of the cemented acetabular component in hip arthroplasty
(2005) In Acta orthopaedica. Supplementum 316.- Abstract
- In total hip arthroplasty cemented fixation of the acetabular component is a generally successful concept, but the rate of aseptic loosening and consequent revision surgery is still too high. One of the crucial factors for longterm implant survival is the initial fixation and stability. This thesis comprises experimental and clinical studies, including radiostereometry (RSA) with up to 5 years follow-up, all investigating the requirements for improved cement fixation of the acetabular component. The results and conclusions of the studies are:
Higher cementation pressure than normally can be achieved is needed for desirable cement penetration, especially as there is obstructing blood circulation in the recipient bone... (More) - In total hip arthroplasty cemented fixation of the acetabular component is a generally successful concept, but the rate of aseptic loosening and consequent revision surgery is still too high. One of the crucial factors for longterm implant survival is the initial fixation and stability. This thesis comprises experimental and clinical studies, including radiostereometry (RSA) with up to 5 years follow-up, all investigating the requirements for improved cement fixation of the acetabular component. The results and conclusions of the studies are:
Higher cementation pressure than normally can be achieved is needed for desirable cement penetration, especially as there is obstructing blood circulation in the recipient bone bed.
There is no difference between cancellous bone from the acetabulum and from load-bearing areas of the
femoral head regarding permeability and structural parameters. Results from studies made on bone from the
more obtainable femoral heads can thus be extrapolated to the acetabulum.
Sequential pressurization of individual anchorage holes before filling the rest of acetabulum with cement is one method of reaching higher pressure and better cement penetration than is achievable with fingerpacking or conventional pressurization. This technique does not impair the cement strength, provided it is performed within
4 minutes of cement mixing and the cement area is kept free from blood or washed with saline.
Pressure applied during the early phase of cementation has the greatest effect on cement penetration.
However, the highest pressure is attained later during cup insertion, but does not further increase the penetration.
Improved cement penetration in the anchorage holes has a stabilizing effect on cup inclination over time.
Early radiolucency, even as a thin demarcation line, is a strong predictor of later cup migration as measured by RSA.
Preparation of the acetabular bone bed is an important factor for cup fixation. Contrary to earlier theories,
removal of the subchondral bone plate, where possible, appears advantageous. It results in a radiographically
superior cement-bone interface, and RSA indicates similar or even better cup stability as compared to retention
of the subchondral bone plate.
Correct preparation of the bone bed in combination with adequate cement pressurization and cup insertion
according to the principles delineated in this thesis should result in better long-term survival in hip arthroplasty. (Less) - Abstract (Swedish)
- Popular Abstract in Swedish
Vid total höftledsartroplastik är cementering av den konstgjorda ledpannan (cupen) ett allmänt sett välfungerande koncept, men frekvensen av lossning och åtföljande omoperation är fortfarande för hög. En av de viktigaste faktorerna för långtidsöverlevnad av protesimplantat är den initialt uppnådda fixationen och stabiliteten. Den föreliggande avhandlingen omfattar såväl experimentella som kliniska studier, inkluderande röntgenstereofotogrammetri (RSA) med upp till 5 års uppföljning av patienterna. Samtliga studier fokuserar på förutsättningarna för en förbättrad fixation av cupen. Resultaten och slutsatserna av studierna är följande:
Högre cementeringstryck än man normalt kan... (More) - Popular Abstract in Swedish
Vid total höftledsartroplastik är cementering av den konstgjorda ledpannan (cupen) ett allmänt sett välfungerande koncept, men frekvensen av lossning och åtföljande omoperation är fortfarande för hög. En av de viktigaste faktorerna för långtidsöverlevnad av protesimplantat är den initialt uppnådda fixationen och stabiliteten. Den föreliggande avhandlingen omfattar såväl experimentella som kliniska studier, inkluderande röntgenstereofotogrammetri (RSA) med upp till 5 års uppföljning av patienterna. Samtliga studier fokuserar på förutsättningarna för en förbättrad fixation av cupen. Resultaten och slutsatserna av studierna är följande:
Högre cementeringstryck än man normalt kan åstadkomma behövs för att erhålla önskvärd cementpenetration, speciellt eftersom det finns intakt blodcirkulation som mottryck i benbädden.
Det är ingen skillnad mellan trabekulärt ben från ledpannan (acetabulum) och från belastade delar av lårbenshuvudet vad gäller permeabilitet eller strukturella parametrar. Resultat från studier gjorda på det mer lättillgängliga lårbenshuvudet kan alltså även appliceras på ledpannan.
Sekventiell tryckcementering av individuella förankringshål innan resten av ledpannan fylls med cement är en metod man kan använda för att nå högre tryck och därmed bättre cementpenetration än vad som kan uppnås med fingerpackning eller konventionell tryckcementering. Den sekventiella tekniken påverkar inte cementstyrkan negativt, förutsatt att den genomförs inom 4 minuter från cementblandningens början och att cementytan hålls fri från blod eller spolas ren med koksalt.
Tryck som läggs på under den tidiga cementeringsfasen har störst effekt på cementpenetrationen. Det högsta trycket uppnås emellertid senare under själva cupsättningen men har då ingen ytterligare inverkan på penetrationen.
Förbättrad cementpenetration i förankringshålen verkar långsiktigt ha en stabiliserande effekt på cupens vinkelposition.
Tidigt uppkomna avgränsningar mellan ben och cement synliga med vanlig röntgen, även i form av bara en tunn linje, är en stark indikation på senare cuprörlighet uppmätt med RSA.
Prepareringen av benbädden i ledpannan är av stor betydelse för cupfixationen. I motsats till tidigare uppfattningar verkar det vara fördelaktigt att ta bort den subchondrala benplattan, där så är möjligt. Detta resulterar i ett röntgenologiskt överlägset ytskikt mellan cement och ben, och RSA indikerar likvärdig eller möjligen ännu bättre cupstabilitet jämfört med om man bevarar den subchondrala benplattan intakt.
Korrekt preparation av benbädden i kombination med adekvat tryckcementering och cupsättning enligt de principer som framläggs i denna avhandling skapar förutsättningar för längre höftprotesöverlevnad. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/544371
- author
- Flivik, Gunnar LU
- supervisor
- opponent
-
- Professor Søballe, Kjeld, University Hospital Arhus, Denmark
- organization
- publishing date
- 2005
- type
- Thesis
- publication status
- published
- subject
- keywords
- traumatology, Kirurgi, ortopedi, traumatologi, orthopaedics, reumatologi, Surgery, Skelett, muscle system, rheumatology locomotion, Skeleton, Cement pressurization, Cement penetration, Acetabulum, Cancellous bone, muskelsystem, Total hip arthroplasty, RSA
- in
- Acta orthopaedica. Supplementum
- volume
- 316
- pages
- 92 pages
- publisher
- Department of Orthopaedics, Lund University
- defense location
- Lund University Hospital Föreläsningssal 1
- defense date
- 2005-03-11 09:00:00
- ISSN
- 1745-3690
- ISBN
- 91-85439-07-X
- language
- English
- LU publication?
- yes
- additional info
- R Juliusson, G Flivik, J Nilsson, L Ryd and R Önnerfält. 1995. Circulating blood diminishes cement penetration into cancellous bone. In vivo studies of 21 arthrotic femoral heads. Acta Orthop Scand, vol 66(3) pp 234-238.G Flivik, X Yuan, L Ryd, R Juliusson and L Lidgren. 1997. Effects of lamination on the strength of bone cement. Acta Orthop Scand, vol 68(1) pp 55-58.MS Thompson, G Flivik, R Juliusson, A Odgaard and L Ryd. 2004. A comparison of structural and mechanical properties in cancellous bone from the femoral head and acetabulum. Proc Inst Mech Eng [H] (J Engineering in Medicine), vol 218(6) pp 425-429.G Flivik, K Wulff, J Sanfridsson and L Ryd. 2004. Improved acetabular pressurization gives better cement penetration. In vivo measurements during total hip arthroplasty. J Arthroplasty, vol 19(7) pp 911-918.G Flivik, J Sanfridsson, R Önnerfält, U Kesteris and L Ryd. . Migration of acetabular components – Effect of cement pressurization and significance of early radiolucency. A randomized 5-year study using Radiostereometry. Acta Orthop, (inpress)G Flivik, I Kristiansson, U Kesteris and L Ryd. . Removal or retention of the subchondral bone plate? – Effect on cemented acetabular component fixation. A randomized 2-year study using Radiostereometry. (submitted)
- id
- b61480fe-896b-4c1e-b0a7-7c5097ec0788 (old id 544371)
- date added to LUP
- 2016-04-04 10:56:11
- date last changed
- 2022-01-29 21:03:58
@phdthesis{b61480fe-896b-4c1e-b0a7-7c5097ec0788, abstract = {{In total hip arthroplasty cemented fixation of the acetabular component is a generally successful concept, but the rate of aseptic loosening and consequent revision surgery is still too high. One of the crucial factors for longterm implant survival is the initial fixation and stability. This thesis comprises experimental and clinical studies, including radiostereometry (RSA) with up to 5 years follow-up, all investigating the requirements for improved cement fixation of the acetabular component. The results and conclusions of the studies are:<br/><br> <br/><br> Higher cementation pressure than normally can be achieved is needed for desirable cement penetration, especially as there is obstructing blood circulation in the recipient bone bed.<br/><br> <br/><br> There is no difference between cancellous bone from the acetabulum and from load-bearing areas of the<br/><br> <br/><br> femoral head regarding permeability and structural parameters. Results from studies made on bone from the<br/><br> <br/><br> more obtainable femoral heads can thus be extrapolated to the acetabulum.<br/><br> <br/><br> Sequential pressurization of individual anchorage holes before filling the rest of acetabulum with cement is one method of reaching higher pressure and better cement penetration than is achievable with fingerpacking or conventional pressurization. This technique does not impair the cement strength, provided it is performed within<br/><br> <br/><br> 4 minutes of cement mixing and the cement area is kept free from blood or washed with saline.<br/><br> <br/><br> Pressure applied during the early phase of cementation has the greatest effect on cement penetration.<br/><br> <br/><br> However, the highest pressure is attained later during cup insertion, but does not further increase the penetration.<br/><br> <br/><br> Improved cement penetration in the anchorage holes has a stabilizing effect on cup inclination over time.<br/><br> <br/><br> Early radiolucency, even as a thin demarcation line, is a strong predictor of later cup migration as measured by RSA.<br/><br> <br/><br> Preparation of the acetabular bone bed is an important factor for cup fixation. Contrary to earlier theories,<br/><br> <br/><br> removal of the subchondral bone plate, where possible, appears advantageous. It results in a radiographically<br/><br> <br/><br> superior cement-bone interface, and RSA indicates similar or even better cup stability as compared to retention<br/><br> <br/><br> of the subchondral bone plate.<br/><br> <br/><br> Correct preparation of the bone bed in combination with adequate cement pressurization and cup insertion<br/><br> <br/><br> according to the principles delineated in this thesis should result in better long-term survival in hip arthroplasty.}}, author = {{Flivik, Gunnar}}, isbn = {{91-85439-07-X}}, issn = {{1745-3690}}, keywords = {{traumatology; Kirurgi; ortopedi; traumatologi; orthopaedics; reumatologi; Surgery; Skelett; muscle system; rheumatology locomotion; Skeleton; Cement pressurization; Cement penetration; Acetabulum; Cancellous bone; muskelsystem; Total hip arthroplasty; RSA}}, language = {{eng}}, publisher = {{Department of Orthopaedics, Lund University}}, school = {{Lund University}}, series = {{Acta orthopaedica. Supplementum}}, title = {{Fixation of the cemented acetabular component in hip arthroplasty}}, volume = {{316}}, year = {{2005}}, }