Bone cement penetration pattern and primary stability testing in keeled and pegged glenoid components

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• 作者：Patric Raiss MD^a ; ^{Patric.Raiss@med.uni-heidelberg.de" rel="nofollow} ; Guido Pape MD^a ; Kerstin Kleinschmidt^a ; Sebastian Jä ; ger^a ; Boris Sowa^a ; Eike Jakubowitz^a ; Markus Loew MD ; PhD^a ; Thomas Bruckner PhD^b ; Markus Rickert MD ; PhD^a
• 关键词：TSA ; shoulder ; arthroplasty ; bone mineral density ; micro-CT
• 刊名：Journal of Shoulder and Elbow Surgery
• 出版年：2011
• 出版时间：July 2011
• 年：2011
• 卷：20
• 期：5
• 页码：723-731
• 全文大小：1155 K
• ISSN：S1058274610004064

文摘

Background

It has been proposed that bone mineral density has an influence on cement penetration in hip and knee arthroplasty. The hypotheses of this study were that: 1) there is a negative correlation between bone mineral density (BMD) and cement penetration in cemented glenoid components; and 2) that implant design has an influence on cement penetration into the glenoid bone.

Methods

BMD of 10 pairs of fresh frozen scapulas was measured. Micro-computed tomography (micro-CT) scans in 3 different sections were analyzed after implantation of keeled and pegged glenoid components using a 3^rd-generation cementing technique with a vacuum mixing system. Cement penetration was analyzed and correlated with BMD. Pull-out strength testing was performed to analyze primary stability.

Results

The overall peak BMD was 0.6 [g/cm²] (range, 0.33–0.98). A strong negative correlation between BMD and mean cement penetration was found for the peg (R² = −.83; P < .003) and for the keel group (R² = −.81; P < .005). Mean cement penetration was 78.4 mm² (range, 60.6–94.2) in the keel and 113.9 mm² (range, 78.2–143.4) in the peg group (P < .0001). In all cases, the components were pulled out of the cement mantle, whereas the bone-cement interfaces remained intact. The mean pull-out strength was 1093N (764–1343N) for keeled and 884N (650–1264N) for pegged components (P < .05).

Conclusion

A modern cementing technique, leading to a deep bonding between bone and cement, is crucial to prevent loosening of glenoid components. The findings of this study might help us to better understand the results of follow-up studies of cemented glenoid implants. Our results could be helpful for the choice of implants in patients with poor bone quality like osteoporosis or rheumatoid arthritis.