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Porosity reduction in acrylic cement is clinically irrelevant
Clinical Orthopaedics and Related Research
|January 26, 1999
Summary
Fatigue failure of acrylic bone cement may not cause aseptic loosening in total hip arthroplasty. In vivo cement behavior and porosity reduction relevance remain uncertain, requiring further clinical trials.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Biomedical engineering
Background:
- Aseptic loosening is a major cause of total hip arthroplasty (THA) failure.
- Acrylic bone cement is widely used in THA fixation.
- The role of cement fatigue and porosity in loosening is debated.
Purpose of the Study:
- To question the established role of acrylic bone cement fatigue failure in aseptic loosening.
- To evaluate the relevance of in vitro fatigue studies to in vivo cement behavior.
- To assess the impact of reduced cement porosity on long-term THA outcomes.
Main Methods:
- Review of existing studies on acrylic bone cement migration and fatigue.
- Consideration of the viscoelastic properties of acrylic bone cement.
- Analysis of clinical evidence regarding cement porosity and THA outcomes.
Main Results:
- Evidence suggests fatigue failure may not be the primary cause of aseptic loosening.
- Viscoelastic properties challenge the applicability of conventional fatigue tests to in vivo conditions.
- Clinical data indicates reduced porosity may not improve long-term THA results.
Conclusions:
- The contribution of acrylic bone cement fatigue to aseptic loosening is questionable.
- In vitro fatigue studies may not accurately reflect in vivo cement performance.
- Further randomized prospective trials are needed to resolve these controversies, though they are unlikely to be conducted.