The use of cement in hip arthroplasty

Written by the surgeons of the Exeter Hip Team and their colleagues from around the world, this book describes 40 years of innovation and development with cemented hip replacement. Topics covered include the basic science behind successful cemented hip replacement, modern surgical techniques and recent advances. There is also extensive coverage of the revision techniques developed at Exeter and elsewhere, focussing on femoral and acetabular impaction grafting. Each chapter is a self-contained article with an emphasis, where appropriate, on practical techniques and surgical tips, supported by line drawings and intra-operative photographs.

Investigation of hybridized polyurethane, glass fibre reinforced cement and steel laminate in structural floor plate systems

Sandwich components have emerged as light weight, efficient, economical, recyclable and reusable building systems which provide an alternative to both stiffened steel and reinforced concrete. These components are made of composite materials in which two metal face plates or Glassfibre Reinforced Cement (GRC) layers are bonded and form a sandwich with light weight compact polyurethane (PU) elastomer core. Existing examples of product applications are light weight sandwich panels for walls and roofs, Sandwich Plate System (SPS) for stadia, arena terraces, naval construction and bridges and Domeshell structures for dome type structures. Limited research has been conducted to investigate performance characteristics and applicability of sandwich or hybrid materials as structural flooring systems. Performance characteristics of Hybrid Floor Plate Systems comprising GRC, PU and Steel have not been adequately investigated and quantified. Therefore there is very little knowledge and design guidance for their application in commercial and residential buildings. This research investigates performance characteristics steel, PU and GRC in Hybrid Floor Plate Systems (HFPS) and develops a new floor system with appropriate design guide lines.

Effect of modular neck variation on bone and cement mantle mechanics around a total hip arthroplasty stem

Background Total hip arthroplasty carried out using cemented modular-neck implants provides the surgeon with greater intra-operative flexibility and allows more controlled stem positioning. Methods In this study, finite element models of a whole femur implanted with either the Exeter or with a new cemented modular-neck total hip arthroplasty (separate, neck and stem components) were developed. The changes in bone and cement mantle stress/strain were assessed for varying amounts of neck offset and version angle for the modular-neck device for two simulated physiological load cases: walking and stair climbing. Since the Exeter is the gold standard for polished cemented total hip arthroplasty stem design, bone and cement mantle stresses/strains in the modular-neck finite element models were compared with finite element results for the Exeter. Findings For the two physiological load cases, stresses and strains in the bone and cement mantle were similar for all modular-neck geometries. These results were comparable to the bone and cement mechanics surrounding the Exeter. These findings suggest that the Exeter and the modular neck device distribute stress to the surrounding bone and cement in a similar manner. Interpretation It is anticipated that the modular-neck device will have a similar short-term clinical performance to that of the Exeter, with the additional advantages of increased modularity.

Revision total hip replacement using the cement-in-cement technique for the acetabular component : technique and results for 60 hips

The technique of femoral cement-in-cement revision is well established, but there are no previous series reporting its use on the acetabular side at the time of revision total hip arthroplasty. We describe the surgical technique and report the outcome of 60 consecutive cement-in-cement revisions of the acetabular component at a mean follow-up of 8.5 years (range 5-12 years). All had a radiologically and clinically well fixed acetabular cement mantle at the time of revision. 29 patients died. No case was lost to follow-up. The 2 most common indications for acetabular revision were recurrent dislocation (77%) and to compliment a femoral revision (20%). There were 2 cases of aseptic cup loosening (3.3%) requiring re-revision. No other hip was clinically or radiologically loose (96.7%) at latest follow-up. One case was re-revised for infection, 4 for recurrent dislocation and 1 for disarticulation of a constrained component. At 5 years, the Kaplan-Meier survival rate was 100% for aseptic loosening and 92.2% (95% CI; 84.8-99.6%) with revision for all causes as the endpoint. These results support the use of the cement-in-cement revision technique in appropriate cases on the acetabular side. Theoretical advantages include preservation of bone stock, reduced operating time, reduced risk of complications and durable fixation.

Cement-in-cement revision for selected Vancouver Type B1 femoral periprosthetic fractures : A biomechanical analysis

The aim of this study was to perform a biomechanical analysis of the cement-in-cement (c-in-c) technique for fixation of selected Vancouver Type B1 femoral periprosthetic fractures and to assess the degree of cement interposition at the fracture site. Six embalmed cadaveric femora were implanted with a cemented femoral stem. Vancouver Type B1 fractures were created by applying a combined axial and rotational load to failure. The femora were repaired using the c-in-c technique and reloaded to failure. The mean primary fracture torque was 117 Nm (SD 16.6, range 89–133). The mean revision fracture torque was 50 Nm (SD 16.6, range 29–74), which is above the torque previously observed for activities of daily living. Cement interposition at the fracture site was found to be minimal.

Flexural performance of an innovative Hybrid Composite Floor Plate System comprising Glass–fibre Reinforced Cement, Polyurethane and steel laminate

This study explored the flexural performance of an innovative Hybrid Composite Floor Plate System (HCFPS), comprised of Polyurethane (PU) core, outer layers of Glass-fibre Reinforced Cement (GRC) and steel laminates at tensile regions, using experimental testing and Finite Element (FE) modelling. Bending and cyclic loading tests for the HCFPS panels and a comprehensive material testing program for component materials were carried out. HCFPS test panel exhibited ductile behaviour and flexural failure with a deflection ductility index of 4. FE models of HCFPS were developed using the program ABAQUS and validated with experimental results. The governing criteria of stiffness and flexural performance of HCFPS can be improved by enhancing the properties of component materials. HCFPS is 50-70% lighter in weight when compared to conventional floor systems. This study shows that HCFPS can be used for floor structures in commercial and residential buildings as an alternative to conventional steel concrete composite systems.

Water and chloride ion penetration resistance of highstrength ultra lightweight cement composite

Durability is a significant issue to focus on for newly developed structural lightweight cement composite (ULCC). This paper presents an experimental study to evaluate the resistance of ULCC to water and chloride ion penetration. Chloride penetrability and sorptivity were evaluated for ULCC (unit weight about 1450 kg/m3) and compared with those of a normal weight concrete (NWC), a lightweight aggregate concrete (LWC), and an ultra lightweight composite with proprietary cementitious binder (DB) (unit weight about 1450 kg/m3) at similar compressive strength of about 60 MPa. Rapid chloride penetrability test, rapid migration test, water absorption (sorptivity) test, and water permeability test were conducted on these mixtures. Results indicate that ULCC and DB had comparable performance. Compared with control LWC and NWC at similar strength level, the ULCC and DB mixtures had higher resistance to chloride ion penetration, lower water absorption and virtually impermeable to water penetration.

Creep and shrinkage of ultra lightweight cement composite

Creep and shrinkage behaviour of an ultra lightweight cement composite (ULCC) up to 450 days was evaluated in comparison with those of a normal weight aggregate concrete (NWAC) and a lightweight aggregate concrete (LWAC) with similar 28-day compressive strength. The ULCC is characterized by low density < 1500 kg/m3 and high compressive strength about 60 MPa. Autogenous shrinkage increased rapidly in the ULCC at early-age and almost 95% occurred prior to the start of creep test at 28 days. Hence, majority of shrinkage of the ULCC during creep test was drying shrinkage. Total shrinkage of the ULCC during the 450-day creep test was the lowest compared to the NWAC and LWAC. However, corresponding total creep in the ULCC was the highest with high proportion attributed to basic creep (≥ ~90%) and limited drying creep. The high creep of the ULCC is likely due to its low E-modulus. Specific creep of the ULCC was similar to that of the NWAC, but more than 80% higher than the LWAC. Creep coefficient of the ULCC was about 47% lower than that of the NWAC but about 18% higher than that of the LWAC. Among five creep models evaluated which tend to over-estimate the creep coefficient of the ULCC, EC2 model gives acceptable prediction within +25% deviations.