title: Calcium phosphate cement composites in revision hip arthroplasty.
abstract: Loosening of the femoral component in a total hip arthroplasty with concomitant bone loss can pose a problem for revision surgery due to inadequate structure in the remaining femur. While impaction allografting has shown promise, it has also shown serious complications, especially with moderate to severe bone loss. It may be possible to stabilize the graft layer with a bioresorbable cement to improve clinical results. This study examines the mechanical properties of a potential morsellized bone-bioresorbable composite. Morsellized bone was mixed with a commercially available bioresorbable cement (alpha-BSM, Etex Corp.) in compositions of 0%, 25%, 50% and 75% bone. Unconfined compression and diametral tensile and confined compression tests were performed to determine the composite mechanical properties. The composition containing 50% bone tended to exhibit the highest uniaxial strengths, as well as the highest confined compression modulus. The uniaxial compressive strength and stiffness of this composition was in the range of cancellous bone. Uniaxial compressive modulus decreased with increasing bone fraction whereas elongation exhibited the opposite trend. Bone fraction had a significant effect on compressive strength (p < 0.0001), compressive modulus (p < 0.0001), elongation (p < 0.01), tensile strength (p < 0.0001) and confined compressive modulus (p = 0.04). The addition of a bioresorbable cement to the allograft layer may improve the properties of the layer, preventing early subsidence seen in some clinical studies of impaction allografting, and therefore improving the clinical results. Further testing is required to evaluate the in vitro mechanical performance, as well as in vivo remodelling characteristics.
authors: Division of Orthopaedic Engineering Research, Department of Orthopaedics and Mechanical Engineering, University of British Columbia, Vancouver, Canada BC V5Z 4E3.
authors: Andrew D
authors: AD
authors: Speirs
authors: Thomas R
authors: TR
authors: Oxland
authors: Bassam A
authors: BA
authors: Masri
authors: Anoush
authors: A
authors: Poursartip
authors: Clive P
authors: CP
authors: Duncan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D001672:Biocompatible Materials / Q000032:analysis / Q000737:chemistry; D001843:Bone Cements / Q000032:analysis / Q000737:chemistry*; D018786:Bone Substitutes / Q000032:analysis / Q000737:chemistry*; D002130:Calcium Phosphates / Q000032:analysis / Q000737:chemistry*; D019245:Compressive Strength; D004548:Elasticity; D005260:Female; D005269:Femur / Q000503:physiopathology*; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D010316:Particle Size; D012086:Reoperation / Q000295:instrumentation
chemical_list: D001672:Biocompatible Materials; D001843:Bone Cements; D018786:Bone Substitutes; D002130:Calcium Phosphates; C020243:calcium phosphate