Use of a polyglycolide lactide cement plug restrictor in total hip arthroplasty.
The use of a polyglycolide lactide cement plug restrictor in cemented femoral fixation during total hip arthroplasty was evaluated. Femoral cement pressurization was evaluated in vitro in a cadaveric model and the host response to polymer degradation was evaluated in vivo in a canine total hip arthroplasty model. Sixteen embalmed anatomic specimen femurs were prepared for cement femoral fixation. The intramedullary canal was plugged with either an ultrahigh molecular weight polyethylene cement plug restrictor or a polyglycolide lactide cement plug restrictor. Peak pressures in the proximal, mid, and distal portions of the cement mantle were recorded during cement insertion, cement pressurization, and implant insertion. There was no difference between the two plug groups in peak pressures throughout the cement mantle during cement insertion, pressurization, or implant insertion. Total hip arthroplasty using a cementless acetabular component and a cemented femoral stem was performed in 24 dogs. The femoral intramedullary canal was plugged with a polyethylene or a biodegradable cement plug restrictor. The dogs were sacrificed at 7 weeks, 10 months, or 15 months. Radiographically, no osteolytic lesions were seen around either plug type. Histomorphometrically, the polyglycolide lactide plugs appeared intact at 7 weeks and partially degraded by 10 and 15 months. In both plug groups, a mild fibrohistiocytic reaction with infiltration of fibrocytes, histocytes, and endothelial cells was seen. No osteolysis was observed. The results of the current study show that femoral cement pressurization can be attained in vitro using a biodegradable cement plug restrictor and that for as long as 15 months in the in vivo canine model there were no adverse reactions associated with use of these plugs compared with conventional ultrahigh molecular weight polyethylene plugs.
Division of Orthopaedic Surgery, Toronto Hospital Western Division, Ontario, Canada.
A J
AJ
Yee
A G
AG
Binnington
T
T
Hearn
K
K
Protzner
V L
VL
Fornasier
J R
JR
Davey
D000818:Animals; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001672:Biocompatible Materials / Q000737:chemistry / Q000627:therapeutic use*; D001843:Bone Cements / Q000737:chemistry / Q000627:therapeutic use*; D002102:Cadaver; D019245:Compressive Strength; D004195:Disease Models, Animal; D004285:Dogs; D005684:Gait; D006801:Humans; D019344:Lactic Acid / Q000737:chemistry / Q000627:therapeutic use*; D008422:Materials Testing; D011100:Polyglycolic Acid / Q000737:chemistry / Q000627:therapeutic use*; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011108:Polymers / Q000737:chemistry / Q000627:therapeutic use*; D011897:Random Allocation; D013718:Tensile Strength; D013997:Time Factors; D016474:Weight-Bearing
D001672:Biocompatible Materials; D001843:Bone Cements; D011108:Polymers; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid