Effects of extracorporeal shockwaves on the stability of the interface between bone and polymethylmethacrylate: an in vitro study on human femoral segments.

The increasing number of revision procedures for failed total arthroplasty requiring difficult cement removal has led to various developments of new instruments and techniques to facilitate this procedure. In this in vitro study the effect of extracorporeal shockwaves on the bone-cement interface was investigated. At first the pressure reduction caused by the passage of shockwaves through compounds consisting of cortical bone-polymethyl-methacrylate and cancellous bone-polymethylmethacrylate by means of a needle pressure probe was measured. Secondly, the mechanical and morphological effects of extracorporeal shockwaves on the polymethylmethacrylate-bone interface of human femoral segments was tested. Using bone cement, stainless steel rods were implanted into cadaveric femoral segments and the polymethylmethacrylate-bone interface was treated with extracorporeal shockwaves. When comparing the treatment and control groups mechanically, radiologically, and microscopically it was not possible to demonstrate evidence of disruption of the interface caused by extracorporeal shockwaves. Instead it was shown that intravasation of bone marrow can be induced by shockwaves. Considering these facts, shockwaves seems not to be good clinical adjunct in revision surgery of failed arthroplasty.