Implications of ageing effects on thermal and mechanical properties of PMMA-based bone cement for THA revision surgery

Magnus Reulbach; Patrick Evers; Crystal Emonde; Hannah Behnsen; Florian Nürnberger; Henning Windhagen; Eike Jakubowitz

doi:10.1016/j.jmbbm.2023.106218

Implications of ageing effects on thermal and mechanical properties of PMMA-based bone cement for THA revision surgery

J Mech Behav Biomed Mater. 2023 Dec:148:106218. doi: 10.1016/j.jmbbm.2023.106218. Epub 2023 Oct 31.

Authors

Magnus Reulbach¹, Patrick Evers², Crystal Emonde¹, Hannah Behnsen³, Florian Nürnberger², Henning Windhagen¹, Eike Jakubowitz⁴

Affiliations

¹ Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hannover, Germany.
² Institute of Materials Science (Werkstoffkunde), Leibniz University Hannover, An der Universität 2, 30823, Garbsen, Germany.
³ Institute of Plastics and Circular Economy, Leibniz University Hannover, An der Universität 2, 30823, Garbsen, Germany.
⁴ Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625, Hannover, Germany. Electronic address: Jakubowitz.Eike@mh-hannover.de.

PMID: 37931550
DOI: 10.1016/j.jmbbm.2023.106218

Abstract

Loosening and infection are the main reasons for revision surgery in total hip arthroplasty (THA). Removing partially detached cemented implant components during revision surgery remains challenging and poses the risk of periprosthetic bone damage. A promising approach for a gentler removal of partially detached prostheses involves softening the PMMA-based bone cement by heating it above its glass transition temperature (T_G), thus loosening the implant-cement bond. It is assumed that the T_G of PMMA-based bone cement decreases in-vivo due to the gradual absorption of body fluid. Reliable data on T_G are essential to develop a heat-based method for removing cemented implant components during revision surgery. The effect of water absorption was investigated in-vitro by ageing PMMA-based bone cement samples for different periods up to 56 days in both Ringer's solution (37 °C) and air (37 °C and 30% humidity). Subsequently, the T_G and Vicat softening temperatures of the samples were determined by differential scanning calorimetry and Vicat tests, respectively, according to prescribed methods. Over the entire ageing period, i.e. comparing one day of ageing in air and 56 days in Ringer's solution, the Vicat softening temperature dropped by 16 °C, while the T_G dropped by 10 °C for Palacos® R PMMA-based bone cement. Water absorption over time correlated significantly with the Vicat softening temperature until saturation of the PMMA-based bone cement was reached. Based on the T_G and Vicat softening temperature measurements, it can be assumed that in body-aged bone cement, an optimal softening can be achieved within a temperature range of 85 °C-93 °C to loosen the bond between the PMMA-based bone cement mantle and the prosthesis stem. These findings may pave the way for a gentler removal of the implant in revision THA.

Keywords: Glass transition temperature; In-vitro ageing; PMMA-based bone cement; Revision surgery; Total hip arthroplasty; Vicat softening temperature; Water uptake.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthroplasty, Replacement, Hip* / methods
Bone Cements / chemistry
Hip Prosthesis*
Polymethyl Methacrylate / chemistry
Reoperation / methods
Ringer's Solution
Water

Substances

Bone Cements
Polymethyl Methacrylate
Ringer's Solution
Water