Effects of temperature on the evolution of stresses at the stem cement interface

Anchorage of the femoral head prosthesis to the shaft of the femur.

Stem surface roughness alters creep induced subsidence and ‘taper-lock’ in a cemented femoral hip prosthesis

Measurement of transient and residual stresses during polymerization of bone cement for cemented hip implants

Debonding of the stem–cement interface occurs inevitably for almost all stem designs under physiological loading, and the wear debris generated at this interface is showing an increasing significance in contributing to the mechanical failure of cemented total hip replacements. However, the influence of protein adsorption onto the femoral stem and the bone cement surfaces has not been well taken into consideration across previous in vitro wear simulations. In the present study, the protein adsorption mechanism and biotribological properties at the stem-cement interface were investigated through a series of frictional tests using bone cements and femoral stems with two kinds of surface finishes, lubricated by calf serum at body temperature. The friction coefficient was dependent on the surface finish of the samples, with an initial much lower value obtained for the polished contacting pairs followed by a sudden increase in the friction coefficient with regard to the tests performed at higher frequencies. The friction coefficient did not change much during the tests for the glass-bead blasted contacting pairs. In addition, proteins from the calf serum were found to adsorb onto both the femoral stem and the bone cement surfaces, and the thickness of the physically adsorbed proteins on the polished metallic samples was more than 10 μm, which was measured using an optical interferometer and validated through a vertical scanning methodology based on Raman spectroscopy. An initial protein adsorption mechanism and biotribological properties at the stem-cement interface were examined in this study, and it suggested that wear at the stem-cement interface may be postponed or reduced by tailoring physicochemical properties of the femoral components to promote protein adsorption.

The fatigue failure of bone cement, leading to loosening of the stem, is likely to be one mode of failure of cemented total hip replacements. There is strong evidence that cracks in the cement are initiated at voids which act as stress risers, particularly at the cement-stem interface. The preferential formation of voids at this site results from shrinkage during polymerisation and the initiation of this process at the warmer cement-bone interface, which causes bone cement to shrink away from the stem. A reversal of the direction of polymerisation would shrink the cement on to the stem and reduce or eliminate the formation of voids at this interface. We have investigated this by implanting hip prostheses, at room temperature or preheated to 44 degrees C, into human cadaver femora kept at 37 degrees C. Two types of bone cement were either hand-mixed or vacuum-mixed before implantation. We found that the area of porosity at the cement-stem interface was dramatically reduced by preheating the stem and that the preheating temperature of 44 degrees C determined by computer analysis of transient heat transfer was the minimum required to induce initial polymerisation at the cement-stem interface. Temperature measurements taken during these experiments in vitro showed that preheating of the stem caused a negligible increase in the temperature of the bone. Reduction of porosity at the cement-stem interface could significantly increase the life of hip arthroplasties.

Influence of femoral stem surface finish on the apparent static shear strength at the stem–cement interface

Cemented total hip replacement has been performed worldwide to treat patients with osteoarthritis and osteonecrosis, with aseptic loosening as its primary reason for revision. It has been indicated that the stem–cement interfacial porosity may contribute to the early loosening of cemented hip prosthesis. In addition, it is generally accepted that the micropores in bone cement surface and in the bulk material are detrimental to the mechanical integrity of bone cement and act as stress concentrators, resulting in generation of fatigue cracks in the cement mantle. Furthermore, it was demonstrated that the micropores also play an important part in initiation and propagation of fretting wear on polished femoral stems. Taking this into consideration, a detailed review of the potential significance of the micropores in bone cement and the methods that could be employed to reduce porosity is given in this article. It was considered that modern cementing techniques are clinically beneficial and should be applied in surgery to further improve the survivorship of cemented total hip replacement.

The stem-cement interface is one of the most significant sites in cemented total hip replacement and has long been implicated in failure of the whole joint system. However, shear strength at this interface has rarely been compared across a range of commercially available bone cements. The present study seeks to address this issue by carrying out a comparative study. The results indicated that the static shear strength was more dependent on cement type than cement viscosity and volume. However, both cement type and viscosity were contributory factors on porosity and micropore size in the cement surface. There was no significant difference between Simplex P and Simplex P with Tobramycin. Although the bone cements were all hand mixed in this study, the static shear strength was significantly larger than the values recorded by other researchers, and the porosity and micropore size showed much lower values. Bone cement transfer films were detected on the stem surface, typically about 4-10 mum thick. They were considered to be an important factor contributing to high friction at the stem-cement interface after initial debonding.

Bone creep and short and long term subsidence after cemented stem total hip arthroplasty (THA)

The changes in the mechanical response of a bone cement reinforcement, comprised of a continuous stainless steel coil imbedded within the PMMA bone cement matrix surrounding the distal tip of the total hip arthroplasty, was investigated. To achieve this, a 3D finite element model depicting two and one half rotations of the coil imbedded within the cement at the distal tip was constructed. Ideally, the wire coil should reduce the radial, and to a greater extent, the hoop stresses developing within the cement and at the cement-stem interface. As a means of comparison, a control model of only bone cement was also built. For the radial stresses, the control had about 4.5 times the compressive stress of the reinforced models (0.039 (+/-0.00065) MPa vs. 0.0087 (+/-0.0012) MPa) at the cement-stem interface. The tensile hoop stresses were also 4.5 times higher (4.272 (+/-0.0147) MPa and 0.95 (+/-0.0052) MPa) for the control than for the reinforced models. This indicates that the wire coil reinforcement is effective in reducing the cement mantle's radial and, more importantly, the hoop stresses which may lead to the failure of both the cement and the implant as a whole.

Although some reports suggest that taper-slip cemented stems may be associated with a higher periprosthetic femoral fractures rate than composite-beam cemented stems, few studies have focused on the biomaterial effect of the polished material on the stem–cement interface. The purpose of this study was to investigate the relationship between surface roughness of materials and bone cement. Four types of metal discs—cobalt-chromium-molybdenum alloy (CoCr), stainless steel alloy 316 (SUS), and two titanium alloys (Ti-6Al-4V and Ti-15Mo-5Zr-3Al)—were prepared. Five discs of each material were produced with varying degrees of surface roughness. In order to evaluate surface wettability, the contact angle was measured using the sessile drop method. A pin was made using two bone cements and the frictional coefficient was assessed with a pin-on-disc test. The contact angle of each metal increased with decreasing surface roughness and the surface wettability of metal decreased with higher degrees of polishing. With a surface roughness of Ra = 0.06 μm and moderate viscosity bone cement, the frictional coefficient was significantly lower in CoCr than in SUS (p = 0.0073). In CoCr, the low adhesion effect with low frictional coefficient may result in excessive taper-slip, especially with the use of moderate viscosity bone cement.

A tapered femoral total hip stem with a debonded stem-cement interface and an unsupported distal tip subjected to constant axial load was evaluated using two-dimensional (2D) axisymmetric finite element analysis. The analysis was performed to test if the mechanical condition suggest that a "taper-lock" with a debonded viscoelastic bone cement might be an alternative approach to cement fixation of stem type cemented hip prosthesis. Effect of stem-cement interface conditions (bonded, debonded with and without friction) and viscoelastic response (creep and relaxation) of acrylic bone cement on cement mantle stresses and axial displacement of the stem was also investigated. Stem debonding with friction increased maximum cement von Mises stress by approximately 50 percent when compared to the bonded stem. Of the stress components in the cement mantle, radial stresses were compressive and hoop stresses were tensile and were indicative of mechanical taper-lock. Cement mantle stress, creep and stress relaxation and stem displacement increased with increasing load level and with decreasing stem-cement interface friction. Stress relaxation occur predominately in tensile hoop stress and decreased from 1 to 46 percent over the conditions considered. Stem displacement due to cement mantle creep ranged from 614 microns to 1.3 microns in 24 hours depending upon interface conditions and load level.

The stem-cement interface experiences fretting wear in vivo due to low-amplitude oscillatory micromotion under physiological loading, as a consequence it is considered to play an important part in the overall wear of cemented total hip replacement. Despite its potential significance, in-vitro simulation to reproduce fretting wear has seldom been attempted and even then with only limited success. In the present study, fretting wear was successfully reproduced at the stem-cement interface through an in-vitro wear simulation, which was performed in part with reference to ISO 7206-4: 2002. The wear locations compared well with the results of retrieval studies. There was no evidence of bone cement transfer films on the stem surface and no fatigue cracks in the cement mantle. The cement surface was severely damaged in those areas in contact with the fretting zones on the stem surface, with retention of cement debris in the micropores. Furthermore, it was suggested that these micropores contributed to initiation and propagation of fretting wear. This study gave scope for further comparative study of the influence of stem geometry, stem surface finish, and bone cement brand on generation of fretting wear.

It has been shown that preheating the femoral stem prior to insertion minimizes interfacial porosity at the stem-cement interface. In this study, the effects of methylmethacrylate monomer temperature prior to mixing on the properties of stem-cement interface and cement polymerization were evaluated for 4 degrees C, room temperature, and 37 degrees C using a test model and cementing techniques that simulated a clinical situation. The nature and extent of interfacial porosity of stem-cement interface was quantified, the static shear strength of the stem-cement interface determined, and the time and temperature of polymerization at the cement-bone interface were measured. Compared to RT monomer, preheating monomer to 37 degrees C produced higher polymerization temperatures and greater initial interfacial shear strength with an unchanged amount of interfacial porosity. Precooling monomer to 4 degrees C produced lower polymerization temperatures and decreased initial interfacial shear strength, with the amount of interfacial porosity unchanged compared to the RT group. Although clinical techniques of preheating or precooling bone cement have some effects on the properties of the stem-cement interface and cement polymerization, they do not appear to enhance implant fixation.

The long term stabilization and durability of cemented total hip replacement (THR) depends on not only the bulk properties of the components but also the interfaces through which they interact. The stem-cement interface has been consistently considered as a weak link in the stem-cement-bone system, being a transitional zone between two materials with significantly different mechanical properties. Previous research concerning this interface has been limited to investigation of interfacial shear strength through in vitro test and finite element analysis (FEA). Until now, a deep insight into the contact characteristics at this interface, especially the interaction between femoral stems with various surface finishes and bone cement, has not been established. In addition, it is still an area of debate whether a permanent fixation can be achieved by utilizing a matt femoral stem, and furthermore it is another matter of concern that a matt femoral stem would cause much more damage to the cement mantle, resulting in an acceleration of aseptic loosening of the femoral stem. This present study investigated the surface topography of stainless steel rods and Simplex P bone cement obtained from a series of pull out tests in order to gain a better understanding of the interaction at the stem-cement interface.