Abstract
Introduction: Prevalence of femoral neck fracture in resurfacing hip arthroplasty continues to question if failure is technique-related or due to the inherent bone quality. This study aimed to correlate cement penetration profile during resurfacing hip with inherent bone density. The hypothesis is that osteoporotic bone is unable to support the prosthesis leading to fatigue failure.
Methods: Fifteen patients scheduled for total hip replacement (THR) were recruited to undergo resurfacing arthroplasty prior to THR. Each patient was implanted with a resurfacing femoral component (BHR, Smith & Nephew, Memphis, TN). Antibiotic simplex cement was inserted one minute after mixing at 18°C to fill 10% of the femoral component volume. The femoral head-implant section was removed and kept in buffered formalin. The patients then proceeded with standard THR. The femoral head-cement-prosthesis section was separated using electrical discharge (ED) machining technique and CT-scanned. The depth and volume of cement penetration were measured from the CT scans and correlated with femoral neck bone densities.
Results: Cement penetration was compared for three groups of bone density: normal, osteopenic, osteoporotic. Average cement thickness were found to be 0.36 ± 0.16mm (proximal), 0.28 ± 0.11 mm (centre) and 0.12 ± 0.05 mm. During hip resurfacing, cement is forced into the porous structure, e.g. the trabeculae and airspaces when the femoral component is fixed onto the head of the femur. In normal bone, the trabeculae is dense and air spaces occupy a small volume of the bone. Greater cement penetration was expected in osteopenic and osteoporotic bones. However, no significant difference was found between cement thickness and volume against inherent patient bone density (p> 0.05). High viscosity of the cement may have prevented more cement to penetrate the bone. While the exterior cortex of the femoral head is strengthened by a cement layer, the interior structure of the femoral neck is still susceptible to fracture at high loads. In addition, increased bone necrosis due to the exothermic reaction during cement fixation may predispose patients to fracture.
Discussion: Resurfacing hip replacement is a viable technique if the fracture risk can be reduced by gaining the best possible cement penetration. This would provide continuous cement stiffness with the bone.
Correspondence should be addressed to Ms Larissa Welti, Scientific Secretary, EFORT Central Office, Technoparkstrasse 1, CH-8005 Zürich, Switzerland
