Implants cemented

The next advance in total hip arthroplasty came with the development of various porous surface treatments which allow bone tissue to grow into the metal porous coating on the femoral stem of the hip implant and on the acetabular component of the total joint replacement. These developments arose because of patients who were not able to tolerate cemented implants because of allergies to the cement, methylmethacrylate. More youthflil patients are better served by a press-fit implant as well. Figure 12 shows the difference between textured and beaded surface-treated orthopedic prostheses. 

The glass-ionomer cement was found to be non-toxic. There were no signs of inflammation or irritation with any of the glass polyalkenoate cement implants even after several months. By contrast a proportion of PMMA cement implants caused swelling and bone reactions. There were also signs of possible hyperaemia (blood congestion) and infarcts (areas deprived of blood supply) and dead tissue. 

Feith, R. (1975). Side effect of acrylic cement implanted into bone. Acta Orthopaedica Scandinavica Supplementum, 161, 1-36. 

Arac SS, Ercan ZS, Turker RK. Prevention by aprotinin of the hypotension due to acryhc cement implantation into the bone. Curr Ther Res 1980 28 554. 

Brossa F, Cigada A, Chiesa R, Paracchini L, Consonni C (1994) Post-deposition treatment effects on hydroxylapatite vacuum plasma spray coatings. Biomaterials 5 855-857 Brown CD, Mealey BL, Nummikoski PV, Bifano SL, Waldrop TC (1998) Hydroxylapatite cement implant for regeneration of periodontal osseous defects in humans. J Periodontol 69 146-157 Brown PW, Fulmer M (1996) The effects of electrolytes on the rates of hydroxylapatite formation at 25 and 388°C. J Biomed Mater Res 31 395-400... 

Takadama H, Kim HM, Koknbo T, Nakamma T (2001a) An X-ray photoelectron spectroscopy stndy of the process of apatite formation on bioactive titanium metal. J Biomed Mater Res 55 185-193 Takadama H, Kim HM, Kokubo T, Nakamttra T (2001b) TEM-EDX study of mechanism of bonelike apatite formation on bioactive titanirrm metal in simulated body flttid. J Biomed Mater Res 57 441-448 Takagi S, Chow LC (2001) Formation of macropores in calcium phosphate cement implants. J Biomed Mater Res 12 135-139... 

Takagi S, Chow LC, Markovic M, Friedman CD, Costantino PD (2001) Morphological and phase characterizations of retrieved calcitrm phosphate cement implants. J Biomed Mater Res 58 36-41 Takechi M, Miyamoto Y, Ishikawa K, Nagayama M, Kon M, Asaoka Kettzo, Sttzrrki K (1998) Effects of added antibiotics on the basic properties of anti-washout-type fast-setting calcitrm phosphate cement. J Biomed Mater Res 39 308-316... 

Takagi S, Chow LC. Formation of macropores in calcium phosphate cement implants. J Mater Sci-Mater M. 2001 Feb 12(2) 135-9. 

Kurashina K, Kurita H, Hirano M, Kotani A, Klein CP, de Qroot K. In vivo study of calcium phosphate cements implantation of an alpha-tricalcium phosphate/ dicalcium phosphate dibasic/tetracalcium phosphate monoxide cement paste. Biomaterials. 1997 Apr 18(7) 539-43. 

Brown GD, Mealey BL, Nummikoski PV, Bifano SL, Waldrop TC. Hydroxyapatite cement implant for regeneration of periodontal osseous defects in humans. J Periodontol 1998 69(2) 146-157. 

Ooms, E.M., Wolke, J.G., van de Heuvel, M.T., Jeschke, B., and Jansen, J.A. Histological evaluation of the bone response to calcium phosphate cement implanted in cortical bone. Biomaterials 24 989-1000,2003. 

Takagi, S., Chow, L.C., Markovic, M., Friedman, C.D., and Costantino, P.D. Morphological and phase characterizations of retrieved calcium phosphate cement implants. J. Biomed. Mater. Res. 58 36-41,2001. 

Kroese-Deutman, H.C., Ruhe, P.Q., Spauwen P.H., and lansen J.A. Bone inductive properties of rhBMP-2 loaded porous calcium phosphate cement implants inserted at an ectopic site in rabbits. Biomaterials 26 1131-1138,2005. 

Ooms, E. M., Wolke, J. G. C., van de Heuvel, R., Jeschke, B., and Jansen, J. A. 2003. Histological evaluation of the hone response to calcium phosphate cement implanted in cortical bone. Biomaterials 24 989-1000. Ooms, E. M., Wolke, J. G. C., van der Waerden, J. P. C. M., and Jansen, J. A. 2002. Trabecular bone response to injectable calcium phosphate (Ca-P) cement. Journal Biomedical Materials Research 61 9-18. Orlovskii, P. V., Komlev, V. S., and Barinov, S. M. 2002. Hydroxyapatite and hydroxyapatite based ceramics. Inorganic Materials 38 1159-72. 

Despite its widespread and successful use, relatively rare complications have been documented with the use of PMMA in orthopaedic surgery. Tissue necrosis can be caused by the high heat of polymerization or by the chemicals themselves [12, 13]. Bone cement implantation syndrome (BCIS) is usually associated with total hip arthroplasty and can be fatal for the patient. Clinical manifestations include hypoxia, hypotension, cardiac arrhythmias and in some cases... 

UHMWPE has been used in knee replacements since the late 1960s, when Frank Gunston developed a cemented implant design at Wrightington Hospital [5, 6]. This early knee replacement resurfaced the individual condyles of the femur and the tibia. Total knee arthroplasty (TKA), which replaces the articulation between the femur and tibia, as well as between the femur and the patella, was developed in the 1970s, primarily at surgical centers in North America. The basic anatomical landmarks and implant features of a typical total knee replacement are illustrated in Figure 7.1. 

There are two methods for making PMMA and bone cement implants. The first one is to use RP for making the implant prototype which is then used as the reference for making the silicon or dental plaster mould from which the implant is fabricated. The second one is to use RP for making the moulds which are directly used to fabricate PMMA or bone cement implants. With tiie recent progress of material development for RP applications, the current RP techniques allow fabricate biocompatible parts and the ones... 

CNC machining can be used for (i) direct milling of the implants fi om Ti blocks or (ii) milling the mould fi om which PMMA or bone cement implants are fabricated [4]. 

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