Modified cemented stem fixation in hip arthroplasty with computer based analysis – Experimental results

27 cemented stems were implanted in fresh‐frozen human cadaver femora with third generation antegrade cementing technique and with prechilled vacuum‐mixed and pre‐pressurized Palacos R bone cement. 3 groups with different implantation techniques were compared according to the achieved cement mantle thickness distribution. Group 1 (modified stem fixation): 7 canulated stems inserted over guidetubes that were fixed in distal synthetic plugs (3 Willert CF‐30 and 4 flanged Charnley stems). The guidetubes served simultaneously for stem centralization and evacuation of the intramedullary cavity. Group 2: 12 stems with distal centralizers with fins (4 flanged Charnley, 8 anatomic cemented AC), and Group 3: 8 stems without centralizer (4 Willert CF‐30 and 4 flanged Charnley). For analysis, each femur was cut into mean 25 cross‐sections (range, 22 ‐ 31). Contact radiographs were taken and digitized with a sampling distance of 0.12mm (204.8 dpi). Using a custom‐made computer program (FemStat 1.001), the cement mantle thickness was determined at mean 650 implant surface points per cross section. Results: The percentage of critical cement mantle thickness was lower for the canulated stems with guidetube. Here 14.1 % of the measurements were smaller than 2mm. For the stems with distal centralizer and without centralizer this was 28.3 % and 28.2 % (p = 0.003 and p = 0.002, U‐test). Cement mantles smaller than 1mm were also reduced for group 1 (2.8 % compared with 4.7 % and 7.5 %) but this was not significant (p = 0.384 and p = 0.094). The stems without centralizers had only slightly inferior cement mantles if compared to stems with distal centralizers with fins (for < 2mm p = 0.571, for < 1mm p = 0.305). Comparing different cementing techniques for one constant type of prosthesis (Charnley) the canulated stems with guide tubes provided a significantly better cement mantle thickness than the stems with distal centralizers (for < 2mm 10.3 % compared with 26.6 %, p = 0.029; for < 1mm 1.5 % compared with 3.4 %, p = 0.343). Distal centralizers failed, as the intramedullary cavity is elliptic in cross section and the gaps between the wings caused malposition. For all stems in group 3 improvement of the cement mantle thickness was predominantly achieved in the distal and middle third of the femur. Conclusion: The implantation technique with canulated stems inserted over a guidetube allows superior stem positioning leading to a more favourable cement mantle.     

Ansatz zur Quantifizierung der Nachhaltigkeit von Beton auf der Baustoffebene

A method for the quantification of the sustainability of concrete on the material level Guaranteeing a high level of sustainability is of special societal importance in civil engineering, on account of the immense investment costs and environmental actions associated with the erection and use of engineering structures and the high demands placed on their lifetime. Sustainable construction is fundamentally characterized by the principle that the ratio between the usefulness of structures to society in relation to the energy and resources consumption resulting from their erection, use and demolition is maximized. Especially in the case of infrastructure construction, this is only possible when the committed building materials demonstrate a high level of performance and durability and – this is the key – when these properties are exploited optimally by the planner. In light of this recog nition, the paper at hand describes possibilities and methods for how the sustainability of the building material concrete – the production of which is responsible for a great portion of global anthropogenic carbon dioxide emissions – can be significantly improved. Green concretes – concretes with strongly reduced cement content – are used as an example of how the sustainability of building materials is affected not only by their environmental impact, but also by their performance and durability. For this purpose a new indicator, the Concrete Sustainability Potential, is introduced, with which the potential for a sustainable use of concrete can be estimated. The application of this indicator is demonstrated here by an example.