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Bone temperature during cementation with a heatsink: a bovine model pilot study.

Spurrier E, Payton O, Latimer M - BMC Res Notes (2014)

Bottom Line: Bone cement is an effective means of supporting implants, but reaches high temperatures while undergoing polymerisation.The mean temperature rise was 10.9°C.These results suggest that using a heatsink while cementing prostheses may reduce the peak bone temperature.

View Article: PubMed Central - HTML - PubMed

Affiliation: Peterborough City Hospital, Bretton Gate, Peterborough PE3 9GZ, UK. edward@edspurrier.co.uk.

ABSTRACT

Background: Bone cement is an effective means of supporting implants, but reaches high temperatures while undergoing polymerisation. Bone has been shown to be sensitive to thermal injury with osteonecrosis reported after one minute at 47°C. Necrosis during cementing may lead to loosening of the prosthesis. Some surgeons fill the joint cavity with cool irrigation fluid to provide a heatsink during cementing, but this has not been supported by research. This paper assesses a simple technique to investigate the efficacy of this method.

Findings: We used a model acetabulum in a bovine humerus to allow measurement of bone temperatures in cementing. Models were prepared with a 50 mm diameter acetabulum and three temperature probe holes; two as close as possible to the acetabular margin at half the depth of the acetabulum and at the full depth of the acetabulum, and one 10 mm from the acetabular rim. Four warmed models were cemented with Palacos RG using a standard mixing system and a 10 mm polyethylene disc to represent an acetabular component. Two of the acetabular models were filled with room temperature water to provide a heatsink. An electronic probe measured temperature at 5 second intervals from the moment of cementing.In the models with no heatsink, peak temperature was 40.3°C. The mean temperature rise was 10.9°C. In the models with a heatsink, there was an average fall in the bone temperature during cementing of 4.4°C.

Conclusions: These results suggest that using a heatsink while cementing prostheses may reduce the peak bone temperature. This study demonstrates a simple, repeatable technique which may be useful for larger trials.

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Related in: MedlinePlus

Temperature trend in wet bone models.
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Figure 3: Temperature trend in wet bone models.

Mentions: In the wet bone model, the average initial temperature was 37.8°C, as technique had been refined and there was a shorter delay before starting cementing. As soon as the water heatsink was applied there was a fall in temperature across all probes with the lowest temperature, 26.4°C, recorded at the probe closest to the acetabulum and at half its depth. The mean fall between starting temperature and minimum temperature was 30.2°C. The temperature then rose steadily but did not return to the starting temperature. The peak end of measurement temperature was 34.9°C recorded in the close, full-depth probe. The closest half-depth probe recorded a fall of 8°C and the mean change in temperature was a fall of 4.4°C. These data are shown in Table 2 and the trend can be seen in Figure 3. It is presumed that the effect of the heatsink is more marked closer to the acetabulum as there is an insulating effect from 10 mm of bone thickness.


Bone temperature during cementation with a heatsink: a bovine model pilot study.

Spurrier E, Payton O, Latimer M - BMC Res Notes (2014)

Temperature trend in wet bone models.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126909&req=5

Figure 3: Temperature trend in wet bone models.
Mentions: In the wet bone model, the average initial temperature was 37.8°C, as technique had been refined and there was a shorter delay before starting cementing. As soon as the water heatsink was applied there was a fall in temperature across all probes with the lowest temperature, 26.4°C, recorded at the probe closest to the acetabulum and at half its depth. The mean fall between starting temperature and minimum temperature was 30.2°C. The temperature then rose steadily but did not return to the starting temperature. The peak end of measurement temperature was 34.9°C recorded in the close, full-depth probe. The closest half-depth probe recorded a fall of 8°C and the mean change in temperature was a fall of 4.4°C. These data are shown in Table 2 and the trend can be seen in Figure 3. It is presumed that the effect of the heatsink is more marked closer to the acetabulum as there is an insulating effect from 10 mm of bone thickness.

Bottom Line: Bone cement is an effective means of supporting implants, but reaches high temperatures while undergoing polymerisation.The mean temperature rise was 10.9°C.These results suggest that using a heatsink while cementing prostheses may reduce the peak bone temperature.

View Article: PubMed Central - HTML - PubMed

Affiliation: Peterborough City Hospital, Bretton Gate, Peterborough PE3 9GZ, UK. edward@edspurrier.co.uk.

ABSTRACT

Background: Bone cement is an effective means of supporting implants, but reaches high temperatures while undergoing polymerisation. Bone has been shown to be sensitive to thermal injury with osteonecrosis reported after one minute at 47°C. Necrosis during cementing may lead to loosening of the prosthesis. Some surgeons fill the joint cavity with cool irrigation fluid to provide a heatsink during cementing, but this has not been supported by research. This paper assesses a simple technique to investigate the efficacy of this method.

Findings: We used a model acetabulum in a bovine humerus to allow measurement of bone temperatures in cementing. Models were prepared with a 50 mm diameter acetabulum and three temperature probe holes; two as close as possible to the acetabular margin at half the depth of the acetabulum and at the full depth of the acetabulum, and one 10 mm from the acetabular rim. Four warmed models were cemented with Palacos RG using a standard mixing system and a 10 mm polyethylene disc to represent an acetabular component. Two of the acetabular models were filled with room temperature water to provide a heatsink. An electronic probe measured temperature at 5 second intervals from the moment of cementing.In the models with no heatsink, peak temperature was 40.3°C. The mean temperature rise was 10.9°C. In the models with a heatsink, there was an average fall in the bone temperature during cementing of 4.4°C.

Conclusions: These results suggest that using a heatsink while cementing prostheses may reduce the peak bone temperature. This study demonstrates a simple, repeatable technique which may be useful for larger trials.

Show MeSH
Related in: MedlinePlus