Femoral cement extraction in revision total hip arthroplasty – an in vitro study comparing computer-assisted freehand-navigated cement removal to conventional cement extraction

Torsten Mumme; Max Julian Friedrich; Henrik Rode; Sascha Gravius; Stefan Andereya; Ralf Müller-Rath; Matias de la Fuente

doi:10.1515/bmt-2014-0041

Article

Femoral cement extraction in revision total hip arthroplasty – an in vitro study comparing computer-assisted freehand-navigated cement removal to conventional cement extraction

Torsten Mumme , Max Julian Friedrich , Henrik Rode , Sascha Gravius , Stefan Andereya , Ralf Müller-Rath and Matias de la Fuente

Published/Copyright: June 6, 2015

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From the journal Biomedical Engineering / Biomedizinische Technik Volume 60 Issue 6

Abstract

Background: Revision surgery of cemented femoral stems in total hip arthroplasty is gaining more and more importance, but cement removal in revision hip arthroplasty may be technically challenging. Conventional manual cement removal can be time consuming and be associated with complications such as cortical perforation, fracture, or bone loss. The aim of this study was to investigate the practicability of computer-navigated cement removal.

Material and methods: In an in vitro study, we examined the removal of the bone cement out of composite bones. To evaluate accuracy, the bones were scanned before and after cement removal with the ISO-C three-dimensional C-arm computed tomography system to determine the amount of unremoved cement and the loss of bone stock. The data of freehand-navigated cement removal is compared to conventionally extracted cement using levers and drills under X-ray control.

Results: The mean time for cement removal was 29±5 min for the conventional method and 32±8 min for the freehand-navigated cement removal. Here, excepting the preparatory examinations, the navigated cement removal only took 13±5 min. The measured temperature during polymerization was 36±5°C and during navigated cement removal was 37±8°C. In the distal part of the femur, cement removal was more accurate with the conventional method compared to the navigated one.

Conclusion: The freehand-navigated cement removal, with the exception of the preparatory examinations, is time saving compared to the conventional method. However, a potential for technical development especially for the milling device and accuracy exist.

Keywords: bone cement; CAS; hip arthroplasty; navigation; revision

Corresponding author: Dr. med. Max Julian Friedrich, Clinic for Orthopaedics and Trauma Surgery, University Hospital and University of Bonn, Sigmund Freud Str. 25, 53127 Bonn, Germany, Fax: +0049-228-28714175, E-mail: max.friedrich@ukb.uni-bonn.de

aThese authors contributed equally.

Acknowledgments

This study was funded by a grant from the BMBF (Federal Ministry of Education and Research) in the OrthoMIT project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest or funding: The authors have declared that no competing interests exist.

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Received: 2014-2-17

Accepted: 2015-5-7

Published Online: 2015-6-6

Published in Print: 2015-12-1

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Articles in the same Issue

https://doi.org/10.1515/bmt-2014-0041

Keywords for this article

bone cement; CAS; hip arthroplasty; navigation; revision