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Fazakas R, Bondar LI, Toth C, Osser B, Ilia I, Miuta CC, Fruja D, Iovanovici DC, Gavrila-Ardelean L, Pop A. Biomechanical Impact of Cementation Technique Variations on Femoral Stem Stability: An In Vitro Polyurethane Model Study. J Clin Med 2025; 14:3291. [PMID: 40429287 PMCID: PMC12112234 DOI: 10.3390/jcm14103291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2025] [Revised: 05/04/2025] [Accepted: 05/06/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: Achieving optimal primary stability in cemented total hip arthroplasty remains a critical factor influencing long-term implant success. Variability in cementation techniques can significantly affect biomechanical performance, yet consensus on best practices is lacking. This study investigates the influence of cementation parameters on femoral stem fixation. Methods: This in vitro comparative study evaluated four cementation techniques-Classic (line-to-line), Press-Fit (undersized reaming), Overreaming (oversized reaming), and Valgus Malpositioning (15° deviation). An experimental model using standardized Polyurethane (PU) bone surrogates was developed. Mechanical testing assessed axial deformation and ultimate load capacity to failure. Results: The Press-Fit technique demonstrated significantly greater deformation (17.10 ± 0.89 mm) but a reduced load capacity (6317.47 ± 518.34 N) compared to the Classic approach. Overreaming and Valgus techniques both showed reduced mechanical performance, with Overreaming yielding the lowest structural integrity. Conclusions: Cement mantle thickness emerged as the primary determinant of biomechanical stability, surpassing the impact of implant positioning. While increased mantle thickness improves energy absorption, it may compromise ultimate strength. These findings underscore the importance of optimizing the cementation technique to balance flexibility and mechanical resistance, guiding surgical protocols toward improved implant longevity. This study introduces a novel integrative approach combining fluoroscopic assessment of cement mantle morphology with mechanical testing in a standardized model, providing new evidence on the relative influence of mantle thickness and implant malposition on femoral stem stability.
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Affiliation(s)
- Roland Fazakas
- Doctoral School of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania; (R.F.); (A.P.)
- Department of Biology and Life Sciences, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
| | - Laura Ioana Bondar
- Department of Biology and Life Sciences, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (C.T.); (B.O.)
| | - Csongor Toth
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (C.T.); (B.O.)
- Faculty of Physical Education and Sport, “Aurel Vlaicu” University of Arad, 310130 Arad, Romania; (I.I.); (C.C.M.)
| | - Brigitte Osser
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (C.T.); (B.O.)
- Faculty of Physical Education and Sport, “Aurel Vlaicu” University of Arad, 310130 Arad, Romania; (I.I.); (C.C.M.)
| | - Iosif Ilia
- Faculty of Physical Education and Sport, “Aurel Vlaicu” University of Arad, 310130 Arad, Romania; (I.I.); (C.C.M.)
| | - Caius Calin Miuta
- Faculty of Physical Education and Sport, “Aurel Vlaicu” University of Arad, 310130 Arad, Romania; (I.I.); (C.C.M.)
| | - Dan Fruja
- Department of General Medicine, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania;
| | - Diana Carina Iovanovici
- Institute of Cardiovascular Diseases Timișoara, Gheorghe Adam Street, No. 13A, 300310 Timisoara, Romania;
| | - Liviu Gavrila-Ardelean
- Prosthetic Dentistry, Faculty of Dental Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania;
| | - Alexandru Pop
- Doctoral School of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania; (R.F.); (A.P.)
- Department of General Medicine, Faculty of Medicine, “Vasile Goldiș” Western University of Arad, 310025 Arad, Romania;
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