Wesley W Flint 1Gregory S Lewis 1Hwa Bok Wee 1Brandon J Bryce 2April D Armstrong 3

Affiliations

  • 1Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA.
  • 2Department of Emergency Medicine, Pinnacle Health, Harrisburg, PA, USA.
  • 3Department of Orthopaedics and Rehabilitation, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA. Electronic address: aarmstrong@hmc.psu.edu.

PMID: 26577127

DOI: 10.1016/j.jse.2015.08.031

Abstract

Background: Numerous studies have documented the concern for progressive radiolucent lines, signifying debonding and subsequent aseptic loosening of the glenoid component. In this study, we compared 3 cementation methods to secure a central peg in 15 cadaveric glenoids.

Methods: Cement application techniques consisted of (1) compression of multiple applications of cement using manual pressure over gauze with an Adson clamp, (2) compression of multiple applications of cement using a pressurizer device, and (3) no compression of a single application of cement. Each glenoid was then imaged with high-resolution micro-computed tomography and further processed by creating 3-dimensional computerized models of implant, bone, and cement geometry. Cement morphology characteristics were then analyzed in each of the models.

Results: There were no significant differences detected between the 2 types of compression techniques; however, there was a significant difference between compression methods and use of no compression at all. All morphologic characteristics of a larger cement mantle were significantly correlated with greater cortical contact.

Conclusions: We demonstrate that compression techniques create a larger cement mantle. Increased size of the cement mantle is associated with increased contact with cortical bone at the glenoid vault. This method for characterizing the cement mantle by micro-computed tomography scanning techniques and 3-dimensional analysis may also be useful in future finite element analysis studies.

Keywords: Total shoulder arthroplasty; cement mantle; cementing technique; glenoid component; micro-CT.