title: Cement-implant interface contamination: possible reason of inferior clinical outcomes for rough surface cemented stems.
abstract: BACKGROUND
  Shape-closed cemented implants rely on a stronger bond and have displayed inferior clinical outcomes when compared to force-closed designs. Implant contamination such as saline, bone marrow and blood prior to cement application has the potential to affect the cement-implant bond. The consequences of implant contamination were investigated in this study.
  
  
  METHODS
  Fifty Titanium alloy (Ti-6Al-4V) dowels were separated into ten groups based on surface roughness and contaminant, and then cemented in polyvinyl chloride tubes. Push-out testing was performed at 1mm per minute. The roughness of the dowel surface was measured before and after the testing. The dowel surface and cement mantel were analyzed using a Scanning Electron Microscopy (SEM) to determine the distribution and characteristics of any debris and contaminants on the surface.
  
  
  RESULTS
  Contaminants largely decreased stem-cement interfacial shear strength, especially for rough surfaces. Saline produced the greatest decrease, followed by blood. The effect of bone marrow was less pronounced and similar to that of oil. Increasing surface roughness increased the interfacial bonding strength, even with contaminants. There was a non-significant increase in mean bonding strength for smooth surfaces with bone marrow and oil contamination. SEM showed that contaminants influence the interfacial bond by different mechanisms. More debris was found on rough samples following testing.
  
  
  CONCLUSIONS
  The results of this study underscore the importance of keeping an implant free from contamination, and suggest if contamination does occur, a saline rinse may further decrease the stability of an implant. The deleterious effects of contamination on rough surface cement bonding were considerable, and indicate that contamination at the time of surgery may, in part, contribute to inferior clinical outcomes for rough surfaced cemented stems.
authors.affiliation: Surgical and Orthopaedic Research Laboratories, University of New South Wales, Prince of Wales Clinical School, Sydney, NSW 2031, Australia ; School of Materials Science & Engineering, University of New South Wales, Sydney, NSW 2052, Australia.
authors.forename: Tian
authors.initials: T
authors.lastname: Wang
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Pelletier
authors.forename: Nicky
authors.initials: N
authors.lastname: Bertollo
authors.forename: Alan
authors.initials: A
authors.lastname: Crosky
authors.forename: William R
authors.initials: WR
authors.lastname: Walsh
keywords: Bone cement; bodily contaminant; bonding strength; in vitro test; surface roughness; titanium implants.
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