The classic: The bonding of prostheses to bone by cement. 1964

Abstract

This Classic Article is a reprint of the original work by Sir John Charnley, The Bonding of Prostheses to Bone by Cement. An accompanying biographical sketch of Sir John Charnley, MD is available at DOI 10.1007/s11999-010-1547-6. The Classic Article is reproduced and adapted with permission and copyright © of the British Editorial Society of Bone and Joint Surgery from Charnley J. The bonding of prostheses to bone by cement. J Bone Joint Surg [Br]. 1964;46-B:518–529.

Fig. 1

Radiograph showing no demarcation between cement and cancellous bone. This prosthesis was tight after three and a quarter years.

Fig. 2

The limits of the cement.

Fig. 3

Condensation in cancellous bone demarcating radiotranslucent plastic and bone. This condensation usually indicates motion between prosthesis and bone.

Fig. 4

Relatively smooth bed lined with fibrous tissue after extraction of cement. This bone had been curetted at time of insertion.

Fig. 5

Showing the relatively smooth surface of cement.

Fig. 6

Showing the rough surface from a specimen where curettage was not used.

Fig. 7

The femur after dissolving away cement with chloroform. The prosthesis had been in situ one and a half years. Note the change of the inner layers of the cortex to cancellous structure without loosening of cement.

Fig. 8

Section of cancellous bone in specimen illustrated in Fig. 7. A indicates site of cement. B is layer of fibrous tissue. C is dead cancellous bone. D is new lamellar bone deposited on dead bone and closing the trabecular space. E shows fatty marrow with normal appearance.

Fig. 9

Absorption of bone at the upper end of the femur. The prosthesis does not settle lower down in the shaft because weight is taken by the cement. Appearances immediately after operation.

Fig. 10

Absorption of bone at the upper end of the femur. The prosthesis does not settle lower down in the shaft because weight is taken by the cement. One and a half years later.

Fig. 11

Absorption of bone at the upper end of the femur. The prosthesis does not settle lower down in the shaft because weight is taken by the cement. Two and a half years after operation and immediately before attempting extraction of the prosthesis. Note that enlargement of the medullary canal as a result of osteoporosis did not indicate looseness of fixation of the cement.

Fig. 12

Post-operative radiological appearance of bone in a case where an uncemented prosthesis was proved to be loose by exploratior.

Fig. 13

Radiological appearances of the same case one and a half years later.

Fig. 14

Showing how extraction was possible only by fracturing the cement to leave behind the cement distal to the fenestrations in the shaft of the prosthesis.

Fig. 15

An Austin Moore prosthesis inserted with cement showing the damage to the metal caused by the violence needed to extract it after one and a half years.

Fig. 16

Same case as Figs. 9, 10 and 11. A prosthesis which defied extraction after two and a half years in situ. The stem of the prosthesis had a serrated surface.

Fig. 17

Same case as Figs. 9, 10 and 11. A prosthesis which defied extraction after two and a half years in situ. Note that enlargement of the medullary canal did not indicate loosening of the attachment of the cement.

Fig. 18

Same case as Figs. 9, 10 and 11. A prosthesis which defied extraction after two and a half years in situ. After failure to extract the head has been removed. (This indicates that cement is more rigidly anchored in the distal part of the femur than in the proximal part (unlike Figs. 14 and 15, where the distal stem of prosthesis is smooth).)