Bone, Cement, and Metal Implant Interface Preparation with a High-Pressure Water Cutter

Abstract

Today, many studies in cemented prostheses focus on the interface between bone and cement as well as between cement and stem. Extensive porosity is aggregated at the cement-stem interface in retrieved cement mantle and laboratory-prepared specimens.^2,3,6 Shrinkage of polymethyl methacrylate (PMMA) causes the formation of gaps between the bone and the cement and between the cement and the prosthesis.⁹ Hematoma formation during the operation will also cause a gap between bone and cement. Porosity, gap, and bleeding at the interfaces may reduce the initial cemented prosthetic stability and thus the long-term survival rate. Examination of the cement-implant interface from cadaver and experimental samples is essential to understanding and thus improving the interface bonding. Clinical studies cannot provide details about the bone-cement and cement-prosthesis interfaces. To perform such investigations, the most common specimen preparation method is using a cutting technique employing a high-speed, water-cooled, circular saw with a ceramic or diamond blade, which is time-consuming.¹⁰ With continued use, the cutting effectiveness of even a diamond saw gradually declines because the diamond saw wears out.⁸ In order to accurately and quickly analyze the interface, we introduced an industrial high-pressure water cutter as a cutting technique for implant and implant-interface investigation. Although the technique has been developed as a cutting tool for soft tissues in visceral surgery^1,4 or bone and cement,⁵ it has not been used for bone, cement, and metal together.