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Ultrasonic cement removal in cement-in-cement revision total hip arthroplasty

Lookup NU author(s): Dr Matthew GermanORCiD, Dr Jennifer Holland



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Objectives Previous studies have evidenced cement-in-cement techniques as reliable in revision arthroplasty. Commonly, the original cement mantle is reshaped, aiding accurate placement of the new stem. Ultrasonic devices selectively remove cement, preserve host bone, and have lower cortical perforation rates than other techniques. As far as the authors are aware, the impact of ultrasonic devices on final cement-in-cement bonds has not been investigated. This study assessed the impact of cement removal using the Orthosonics System for Cemented Arthroplasty Revision (OSCAR) on final cement-in-cement bonds. Methods A total of 24 specimens were manufactured by pouring cement (Simplex P Bone Cement, Stryker) into stainless steel moulds, with a central rod polished to Stryker Exeter V40 specifications. After cement curing, the rods were removed and eight specimens were allocated to each of three internal surface preparation groups: 1) burr; 2) OSCAR; and 3) no treatment. Internal holes were re-cemented, and each specimen was cut into 5 mm discs. Shear testing of discs was completed by a technician blinded to the original grouping, recording ultimate shear strengths. Scanning electron microscopy (SEM) was completed, inspecting surfaces of shear-tested specimens. Results The mean shear strength for OSCAR-prepared specimens (33.6 MPa) was significantly lower than for the control (46.3 MPa) and burr (45.8 MPa) groups (p < 0.001; one-way analysis of variance (ANOVA) with Tukey’s post hoc analysis). There was no significant difference in shear strengths between control and burr groups (p = 0.57). Scanning electron microscopy of OSCAR specimens revealed evidence of porosity undiscovered in previous studies. Conclusion Results show that the cement removal technique impacts on final cement-in-cement bonds. This in vitro study demonstrates significantly weaker bonds when using OSCAR prior to re-cementation into an old cement mantle compared with cement prepared with a burr or no treatment. This infers that care must be taken in surgical decision making regarding cement removal techniques used during cement-in-cement revision arthroplasty, suggesting that the risks and benefits of ultrasonic cement removal need consideration.

Publication metadata

Author(s): Liddle A, Webb M, Clement N, Green S, Liddle J, German M, Holland J

Publication type: Article

Publication status: Published

Journal: Bone & Joint Research

Year: 2019

Volume: 8

Issue: 6

Pages: 246-252

Online publication date: 20/06/2019

Acceptance date: 07/06/2019

Date deposited: 28/06/2019

ISSN (electronic): 2046-3758

Publisher: British Editorial Society of Bone and Joint Surgery


DOI: 10.1302/2046-3758.86.BJR-2018-0313.R1


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