To achieve this, the bone is first sealed distally with an intramedullary stopper. To illustrate, Hailer showcased the “whiteout” as a distinct quality feature: If done correctly, no transition between the cemented endoprosthesis and the cortical bone is visible on the X-ray. In addition to the differentiation of the patient groups – regarding to age, gender and comorbidities – the correct cementing technique is crucial for treatment success. Given this pioneering role, the expert found it curious that the technique is hardly used in operations in Germany: ‘We should cement a lot more,’ was his assessment. In addition, Hamburg University Medical Center was among the first to add antibiotics to the bone cement. For example, PMMA – also known as Plexiglas –, which is today widely used as bone cement, was invented here, the head of the Department of Orthopaedics, Trauma and Hand Surgery at Uppsala University Hospital listed. The third speaker of the symposium, Univ Prof Dr Nils Hailer emphasised the special role of Germany in cemented arthroplasty. These have not been confirmed, the expert pointed out. 21, 22 This type of implant also benefits from cemented fixation, 18 and Wirtz once more emphasised the advantages of antibiotic-loaded bone cement in this context: ‘It may of course be a matter of cost, but the evidence clearly speaks in favour of it.’ He also addressed concerns regarding antibiosis leading to increased formation of resistant pathogens. The export also recommended the use of dual-mobility cups – especially for older patients. ‘Especially in older patients, this significantly increases the risk of periprosthetic fractures.’ 19 Study results therefore argue in favour of implants with a matte surface (R a <2.5 µm), which create a firm bond with the bone cement and thus reduce the risk of fractures. This axial migration can lead to longitudinal cracks in the cement mantle. The choice of implant surface can also prevent complications, the expert continued: so-called Exeter implants with a highly polished surface (R a <0.1µm) do not bond with the surrounding bone cement, but jam in the surrounding mantle. Here, too, registers show a significant advantage of cemented treatment. This also applies to patients with femoral neck fractures. Especially women with osteoporosis within this age group benefit significantly from the use of cement, Wirtz said.
16 This poses an additional challenge for arthroplasty: older patients frequently suffer from deficits in primary stability due to osteoporosis, cognitive and motor impairments, a higher risk of dislocation and falls, and are also more frequently affected by complications during surgery.Ĭementing can noticeably reduce the revision rate for elective total hip arthroplasties, the expert clarified, referring to current figures 16: ‘This is mainly due to periprosthetic fractures, which has an increased occurrence rate in cementless technique procedures for patients aged 75 upwards’. Accordingly, this age group accounts for a large proportion of hip replacements – about 41.6% of the more than 147,000 annual procedures are performed on patients over 75. Strong representation of patients over 75įollowing up, Prof Dieter Christian Wirtz also picked up on the importance of patient age: ‘In patients over 75 years, osteoarthritis is – after high blood pressure – the second most common condition requiring treatment, even more so than diabetes or coronary heart disease,’ said the expert from the Clinic and Polyclinic for Orthopaedics and Trauma Surgery at Bonn University Hospital. 13, 14, 15 ‘I have been using this cement for a long time in all my high-risk and elderly patients because it greatly reduces the infection rate.’ ‘Cement is not only an effective means of fixing the prosthesis in place, it is also a good vector to deliver antibiotics to where they are needed in a highly concentrated way.’ In particular, high-dose, double-loaded bone cement (gentamicin and clindamycin G+C) shows longer and broader effects. Also, mortality over the entire period of hospitalisation decreases 12, the expert pointed out. Studies have shown how patients benefit from cemented arthroplasty in femoral neck fractures compared to cementless stem anchorage, it significantly lowers periprosthetic fracture rates, prolonging the implant’s life by a factor of 3 to 4 11. In addition, antibiotic-loaded bone cement has been shown to be an effective tool for infection control, Liener explained. Cement is not only an effective means of fixing the prosthesis in place, it is also a good vector to deliver antibiotics to where they are needed in a highly concentrated way Ulrich Liener
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