Understanding Cement Disease and Its Repercussions
As if going through a hip replacement were not difficult enough for patients, many find themselves faced with ongoing problems. One of those potential problems is “cement disease”. While there is some controversy surrounding whether this condition actually exists, the US National Library of Medicine of the National Institutes of Health points out that not only does it exist, but that it can eventually lead to total failure of the prosthetic, combined with immobilizing pain. This is in contrast to those medical professionals who argue that cement disease is just a form of loosening and the biologic reactions in patients have nothing to do with the cement or debris from deteriorating prosthetics.
What Is Cement Disease?
According to the Medical Dictionary for the Health Professions and Nursing, cement disease is defined as, “the osteolysis that frequently occurs in association with loosening of cemented total hip replacements; the microscopic particles of polymethylmethacrylate cement induce a biologic reaction by osteoclasts leading to bone resorption and progressive bone loss.”
According to the US National Library of Medicine of the National Institutes of Health, “the biomaterial properties of the cement used for fixation also contribute to the pathologic state that separates this disease from other forms of loosening, and that cement disease does in fact exist.”
The underlying problem here seems to be stress and activity related. Most elderly patients with relatively sedentary lives experience few to no problems with their prosthetics. The problems are more common with young people, those with very active lifestyles, athletes and performers, as well as those with weight problems.
In these instances, high levels of activity and the stress caused by overweight/obesity cause significant stress as well as wear and tear on the prosthetic, leading to the cement failing, and the possibility of developing cement disease. There is currently no alternative to cement – the only long-term solution for individuals in need of hip replacement but whom fall into the categories where cement disease is most prevalent is to eliminate cement altogether. Ongoing research is being conducted for alternatives to cement, including different adhesive materials to hold the bone and prosthetic together, as well as in the design of prosthetics that allows press-fit or biologic ingrowth from the patient’s natural bone. Some of these new prosthetics include ceramic on ceramic and ceramic on polyethylene, as well as metal on metal constructions.
Treating Cement Disease
Unfortunately, the only true treatment for cement disease (or osteolysis to be more precise) is to have the prosthetic removed, the bone and tissue cleaned and prepared, and a new prosthetic installed. In short, the only option is to have another hip replacement. With the newer hip replacement options, bone wear and microscopic particle accumulation/damage are not as significant. However, there is no definitive answer as to which is the best implant device. Determining which option to use will require a consultation with your orthopedic doctor and a discussion of the pros and cons offered by the various prosthetic devices available.
The Situation for New Hip replacements
To a large extent, cement disease affects those with older hip replacements, although it is a possibility in the future for those with active lifestyles or weight problems. With that being said, the number of alternative materials on the market today and the amount of ongoing research into alternative prosthetic types, as well as new grouting materials means that individuals who do not yet need a hip replacement, but who will eventually, have less to fear from this condition. It’s hoped that ongoing research and development will eventually eliminate it completely.
Surgeon’s Advice | Leon Mead MD Orthopedic Doctor | 730 Goodlette Road North, Suite 201 Naples Florida 34102 | Phone: (239) 262-1119