Kasten Philip, Jandl Nico Maximilian, Zeifang Felix, Dallmann Frank, Jakobs Stefan, Stalder Kevin, Niemeier Andreas
Orthopädisch Chirurgisches Centrum (OCC), Tübingen, Germany.
Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Shoulder Elbow Surg. 2023 Feb;32(2):383-391. doi: 10.1016/j.jse.2022.08.022. Epub 2022 Oct 4.
There are no generally accepted guidelines for polyethylene (PE) glenoid component cementation techniques. In particular, it is not known whether the backside of a PE glenoid should be fully or partially cemented-or not cemented at all. We hypothesized that cementing techniques would have an impact on cement mantle volume and integrity, as well as biomechanical stability, measured as micromotion under cyclic loading.
To address our hypothesis, 3 different cementation techniques using a single 2-peg PE glenoid design with polyurethane foam were compared regarding (1) the quality and quantity of the cement mantle and (2) biomechanical stability after cyclic loading in vitro. Eight identically cemented glenoids per group were used. Group A underwent cement application only into the peg holes, group B received additional complete cement mantle application on the backside of the glenoid, and group C received the same treatment as group B but with additional standardized drill holes in the surface of the glenoid bone for extra cement interdigitation. All glenoids underwent cyclic edge loading by 10 cycles according to ASTM F2028-14. Before and after loading, cement mantle evaluation was performed by XtremeCT and biomechanical strength and loosening were evaluated by measuring the relative motion of the implants.
The cement mantle at the back of the implant was incomplete in group A as compared with groups B and C, in which the complete PE backside was covered with a homogeneous cement mantle. The cement mantle was thickest in group C, followed by group B (P = .006) and group A (P < .001). We did not detect any breakage of the cement mantle in any of the 3 groups after testing. Primary stability during cyclic loading was similar in all groups after the "running-in" phase (up to 4000 cycles). Gross loosening did not occur in any implant.
Coverage of the PE glenoid with cement was reproducible in the fully cemented groups (ie, groups B and C) as compared with relevant cement defects in group A. The addition of cement to the back of the PE glenoid and additional drill holes in the glenoid surface did not improve primary stability in the tested setting.
对于聚乙烯（PE）关节盂部件的骨水泥固定技术，目前尚无普遍接受的指南。特别是，尚不清楚PE关节盂的背面应完全、部分骨水泥固定还是根本不进行骨水泥固定。我们假设骨水泥固定技术会对骨水泥壳的体积和完整性以及生物力学稳定性产生影响，生物力学稳定性通过循环加载下的微动来衡量。
为验证我们的假设，比较了使用带有聚氨酯泡沫的单双柱PE关节盂设计的3种不同骨水泥固定技术，比较内容包括（1）骨水泥壳的质量和数量，以及（2）体外循环加载后的生物力学稳定性。每组使用8个相同骨水泥固定的关节盂。A组仅在柱孔中应用骨水泥，B组在关节盂背面额外进行完整的骨水泥壳涂抹，C组接受与B组相同的处理，但在关节盂骨表面有额外的标准化钻孔以实现额外的骨水泥交叉结合。根据ASTM F2028 - 14标准，所有关节盂均接受10个循环的循环边缘加载。在加载前后，通过XtremeCT进行骨水泥壳评估，并通过测量植入物的相对运动来评估生物力学强度和松动情况。
与B组和C组相比，A组植入物背面的骨水泥壳不完整，B组和C组中完整的PE背面覆盖有均匀的骨水泥壳。C组的骨水泥壳最厚，其次是B组（P = 0.006）和A组（P < 0.001）。测试后，我们在3组中均未检测到骨水泥壳有任何破损。在“磨合”阶段（直至4000个循环）后，所有组在循环加载期间的初始稳定性相似。任何植入物均未发生明显松动。
与A组中相关的骨水泥缺陷相比，在完全骨水泥固定组（即B组和C组）中，用骨水泥覆盖PE关节盂具有可重复性。在PE关节盂背面添加骨水泥以及在关节盂表面额外钻孔在测试环境中并未改善初始稳定性。
