Bone Cement.ppt

Bone Cement PMMA(polymethylmethacrylate ) Hill and Crawfold 1927 John Charnley 1950s low friction arthroplasty fixed with PMMA FDA 1971 The three generations of cement technique First generation techniques (-1970s) finger packing bowl mixing Second generation techniques (1970s-1990s) the use of an intramedullary plug cleaning of the bone bed drying of the bone retrograde cement insertion femoral and acetabular components to better match patient geometry The three generations of cement technique Third generation technique(1990s- ) includes second generation techniques porosity reduction in the cement pressurization of the cement mantle after insertion centralization of the femoral stem within the cement mantle Application areas Hip Total hip replacement (THR) Hybrid hip / Bipolar hip Revision hip Knee Total knee replacement (TKR) Uni knee Revision knee Spine vertebroplasty Modern Cementing Techniques Clean bone bed High and reprosucible bone cement quality Good cement filling Safe working environment Bone bed preparation To remove remaining bone particles and debris *5 Mixing and delivery Porosity in bone cement History mixing and delivery systems Vacuum mixing and collection under vacuum Closed mixing system Reproducible, homogenous mix Cement delivery Gold standard Vacuum mixing in the Optivac Vacuum mixing in the Palamix *6 *7 *8 * * PMA: a powder containing copolymers based on the substance methacrylate MMA : a liquid monomer methylmethacrylate Reaming Anchorage holes Cement restrictor Brushing High-pressure pulse lavage The bone cavity should be shaped to provide an even cement layer between the bone and prosthesis. Anchorage holes will incresase the contact area between bone and cement, providing for better fixation. The anchorage holes may be drilled and/or impacted.