Effects of Preheating of Hip Prostheses on the Stem-Cement Interface

Background: Debonding of the cement from metal implants has been implicated in the loosening of cemented total hip prostheses. Strengthening of the stem-cement interface has been suggested as a way to prevent loosening of the component. Previously, it was reported that preheating the stem to 44°C reduced the porosity of the cement at the stem-cement interface. The purpose of this study was to determine the effect of stem preheating on the characteristics of the stem-cement interface.

Methods: The effects of stem preheating, at temperatures of 37°C, 44°C, and 50°C, on the stem-cement interface were studied in a test model and a preparation that closely simulated the clinical situation. Static interface strength was determined initially and after the stems had been kept in isotonic saline solution at 37°C for two weeks. Fatigue lifetimes were measured, and the nature and extent of porosity at the interface were quantified.

Results: Stem preheating had significant effects on the stem-cement interface. Stems preheated to 37°C had greater interface shear strength than stems at room temperature both initially (53% greater strength) and after simulated aging (155% greater strength). Fatigue lifetimes were also improved, and there was a >99% decrease in interface porosity. The setting time of the cement decreased 12%, and the maximum temperature at the cement-bone interface increased 6°C. Similar effects were found after preheating to 44°C and 50°C.

Conclusions: Stem preheating had significant effects on the stem-cement interface, with significant improvements in the shear strength and cement porosity of the interface. Also, polymerization temperatures at the cement-bone interface increased. The possible biological effects of these increased interface temperatures at the cement-bone interface require further study.