Effect of pressurization on methylmethacrylate-bone interdigitation: An in vitro study of canine femora

Aseptic mechanical loosening of the femoral and acetabular components is a major long term complication of total hip arthroplasty. Pressurized injection of bone cement (polymethylmethacrylate) has been advocated for increasing cement-bone interlock. To determine the relationship between cement intrusion pressure and its penetration into cancellous bone, an in-vitro study of paired, fresh frozen canine femora was conducted. Methacrylate cement was injected at predefined constant pressures from 0.11 to 1.23 MPa (16-175 psi). The penetration was quantified for each injection pressure. The results showed a positive logarithmic relationship between the relative penetration and the intrusion pressure, the former reaching a near asymptotic value at approximately 0.70 MPa (100 psi). Unequal radial distribution of cement within the metaphysis was demonstrated. Greater penetration was observed into the proximal postero-lateral cancellous bone bed as compared to other regions. The relationship between cement penetration and bone size was explored at a single-constant pressure of 0.35 MPa (50 psi). Although absolute cement penetration was found to be linearly related to the bone size, the relative penetration remained nearly constant with bone size.