Effects of pre-cooling and pre-heating procedures on cement polymerization and thermal osteonecrosis in cemented hip replacements.

Numerical studies were performed to investigate bone cement polymerization, temperature history and thermal osteonecrosis in cemented hip replacements with finite element methods. In this paper, the effects of pre-cooling and pre-heating of the prosthesis and/or the cement prior to implantation were simulated. It was found that the cement polymerization initiated near the bone-cement interface and progressed toward the prosthesis when both the cement and prosthesis were initially at room temperature. When the prosthesis and/or cement were pre-cooled, a reduction of the peak temperature at the bone-cement interface resulted, and this may reduce thermal osteonecrosis. However, this also slowed the polymerization process, and may result in a weaker bone cement. If the prosthesis was significantly initially heated, bone cement polymerization reversed reaction direction, started from the cement-prosthesis interface and proceeded toward the bone. Such polymerization direction may reduce or eliminate the formation of voids at the cement-prosthesis interface. Numerical results also showed that pre-heating seemed unlikely to produce significant thermal damage to the bone. The method of pre-heating the prosthesis prior to implantation may decrease the likelihood of cement-prosthesis loosening and increase the life of total hip arthroplasty.