Factors affecting the cement penetration of a hip resurfacing implant: an in vitro study

An understanding of how the cementing technique influences cement penetration is important for surgeons to plan and conduct hip resurfacing procedures. Therefore the aim of this study is to determine the influence of the following parameters on cement penetration: use of pulse lavage, type of cement, and the standing period of the cement. Nine fresh frozen paired whole cadaver femora were used to investigate cement penetration. The femora were divided into three paired groups: (A) compared the use of pulse lavage to no pulse lavage, (B) compared two low viscosity bone cements SULCEM-3 (Zimmer GmbH, Switzerland) and Surgical Simplex (Stryker Orthopaedics, USA), and (C) compared bone cement viscosities using standing times of 1.5 min. and 3 min. The Durom Hip Resurfacing implant (Zimmer GmbH, Switzerland) was used in all groups. A single slice was taken out of the center of each head. Cement penetration ratio (penetration area divided by the bone area enclosed by implant) and mean cement penetration depth were measured. Cement penetration is increased using pulse lavage, and has the tendency to increase with increasing the cement standing time from 1.5 to 3 min. No difference in cement penetration was found when different cement brands of comparable viscosity were used.