Biomechanics of interfaces for cemented joint replacements: A systematic review

Abstract

The fixation of cemented implants in joint replacement procedures involves two critical interfaces: the bone-cement interface and the cement-implant interface. Although cemented implants—such as those used in hip, shoulder, elbow, vertebrae, knee, and ankle arthroplasty—are often preferred over uncemented ones in specific patient populations, failure can still occur due to suboptimal interfacial conditions. Therefore, a comprehensive understanding of the interfacial factors influencing mechanical integrity and long-term implant performance is essential for orthopaedic surgeons, clinicians, and biomedical researchers. This review focuses on evaluating the role of key factors in relation to interfacial failure mechanisms, debonding strength, fracture behaviour, implant stability, and revision rates of cemented implants. Key interfacial characteristics, including interfacial friction, surface coatings, surface roughness, groove geometry, porosity, cement spacers, implant design, cement viscosity, mantle thickness, and penetration depth, have been identified as major contributors to the interfacial mechanical integrity of cemented implants. Emphasizing the mechanical behaviour and structural integrity of the bone-cement and cement-implant interfaces, this study presents a biomechanical perspective to enhance the understanding of orthopaedic applications. The review incorporates findings from experimental, computational, and clinical follow-up studies, highlighting the role of PMMA bone cement in improving interfacial biomechanics. Moreover, it identifies critical research gaps and methodological limitations within existing literature. Addressing these gaps through future investigations will contribute to optimizing the fixation, stability, and long-term performance of cemented implants in clinical settings.