The Importance of Establishing the Best Bone-Cement Interface

  • Clive Lee


This chapter describes the interface between bone cement and bone, pointing out that the operating surgeon is responsible for establishing that interface at the time of surgery. If the interface is not well established at the start, the replacement joint has no chance of long-term function. The cement-bone interface is a mechanical interlock between the two materials that can be enhanced by the preparation of the bone surface, pressurising cement into that surface and holding the cement under pressure until its viscosity is such that bone bleeding cannot displace it. Effective pressurisation can only be obtained using suitable instruments. The effect of heating the femoral stem before insertion is described. The surgeon has to be aware of the effect of all the variables in order that the strongest possible interface is obtained at the time of surgery.


Bone Cement Femoral Stem Radiolucent Line Mechanical Interlock Bone Bleeding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Askew MJ, Steege JW, Lewis JL, Ranieri JR, Wixson RL (1984) Effect of cement pressure and bone strength on polymethylmethacrylate fixation. J Orthop Res, 1(4): 412–420PubMedGoogle Scholar
  2. 2.
    Benjamin JB, Volz RG, Gie GA, Ling RSM, Lee AJC (1987) Cementing technique and the effects of bleeding. J Bone Joint Surg 69-B:620–624Google Scholar
  3. 3.
    Bishop NE, Ferguson S, Tepic S (1966) Porosity reduction in bone cement at the cement-stem interface. J Bone Joint Surg 78-B:349–356Google Scholar
  4. 4.
    Cadle D, James M, Ling RSM, Piper RF, Pryer DL, Wilmshurst CC (1972) Cardiovascular responses after methylmethacrylate cement. BMJ 4:107PubMedGoogle Scholar
  5. 5.
    Draenert K. Histomorphology of the bone-to-cement contact. In: Draenert K, Draenert Y, Garde U, Ulrich Ch (eds) Manual of cementing technology. Springer, Berlin Heidelberg New York Tokyo, pp 4–18Google Scholar
  6. 6.
    Dunne NJ, Orr JF, Beverland DE (2004) Assessment of cement introduction and pressurization techniques. Proc Inst Mech Engrs Vol. 218, Part H, Eng in Med H1:11–25Google Scholar
  7. 7.
    Gilbert JL, Hasenwinkel JM, Wixson RL, Lautenschlager EP (2000) A theoretical and experimental analysis of polymerisation shrinkage of bone cement: a potential major source of porosity. J Biomed Mater Res 52:210–218CrossRefPubMedGoogle Scholar
  8. 8.
    Haas SS, Brauer GM, Dickson G (1975) Characterization of polymethylmethacrylate bone cement. J Bone Joint Surg 57-A:380–391Google Scholar
  9. 9.
    Halawa M, Lee AJC, Ling RSM, Vangala SS (1978) The shear strength of trabecular bone from the femur, and some factors affecting the shear strength of the cement-bone interface. Arch Orthop Traum Surg 92:19–30Google Scholar
  10. 10.
    Hankin FM, Campbell SE, Goldstein SA, Matthews LS (1984) Hydrogen peroxide as a topical hemostatic agent. Clin Orthop Rel Res 186:244–248Google Scholar
  11. 11.
    Heyse-Moore GH, Ling RSM (1983) Current cement techniques. In: Marti RK (ed) Progress in cemented total hip surgery and revision. Exerpta Medica, AmsterdamGoogle Scholar
  12. 12.
    Iesaka K, Jaffe WL, Kummer FJ (2003) Effects of preheating of hip prostheses on the stem-cement interface. J Bone Joint Surg 85-A:421–427PubMedGoogle Scholar
  13. 13.
    Iwaki H, Scott G, Freeman MAR (2002) The natural history and significance of radiolucent lines at a cemented femoral interface. J Bone Joint Surg 84-B:550–555Google Scholar
  14. 14.
    Lee AJC, Ling RSM (1974) A device to improve the extrusion of bone cement into the bone of the acetabulum in the replacement of the hip joint. Biomedical Engineering 9:522–524PubMedGoogle Scholar
  15. 15.
    Li C, Schmid S, Mason J (2003) Effects of pre-cooling and pre-heating procedures on cement polymerisation and thermal necrosis in cemented hip replacements. Med Eng Phys 25:559–564CrossRefPubMedGoogle Scholar
  16. 16.
    Ling RSM (1986) Observations on the fixation of implants to the bony skeleton. Clin Orthop Rel Res 210:80–96Google Scholar
  17. 17.
    Malchau H et al. (2002) Prognosis of total hip replacement — update of results and risk-ratio analysis for revision and re-revision from the Swedish National Hip Arthroplasty Register 1979–2000. 69th Annual Meeting of the AAOS, February 13–17, 2002, Dallas, USAGoogle Scholar
  18. 18.
    National Joint Registry for England and Wales — Summary Report to the 1st Annual Report (2004). National Joint Registry (NJR) Centre, Harwell, Oxfordshire OX11 0QJ, EnglandGoogle Scholar

Copyright information

© Springer Medizin Verlag Heidelberg 2005

Authors and Affiliations

  • Clive Lee
    • 1
  1. 1.Department of Engineering, Computer Science and MathematicsExeterUK

Personalised recommendations