Comparison of different cement application techniques for tibial component fixation in TKA

Schlegel, Ulf J.; Bishop, Nick; Püschel, Klaus; Morlock, Michael M.; Nagel, Katrin

doi:10.1007/s00264-014-2468-x

Cited by 41 publications

(28 citation statements)

References 41 publications

(60 reference statements)

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“…Possible influencial factors may be reduced to shortcomings in surgical technique or implant-related issues. Cementation technique still remains a matter of discussion in primary TKA [3, 18, 19, 24]. Kopinski et al found a connection between the use of high-viscosity cement and early tibial debonding [11].…”

Section: Discussionmentioning

confidence: 99%

Modern cemented total knee arthroplasty design shows a higher incidence of radiolucent lines compared to its predecessor

Staats

Wannmacher

Weihs

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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PurposeTo prevent early failure it is necessary to evaluate modern TKA system for possible shortcomings during implantation. The aim of this study was to evaluate the radiographic outcome and short-term survival of a modern cemented primary TKA system compared to its predecessor.MethodsThe authors reviewed 529 primary cemented TKAs [276 Attune (ATT) and 253 PFC Sigma (PFC)], which were implanted between 2014 and 2017 concerning the radiographic outcome and short-term survival. Radiographs were taken before discharge, 6 weeks, 6 months and 12 months postoperatively. Radiographic analysis was performed by two independent assessors using the Modern Knee Society Radiographic Evaluation System.ResultsThe incidence of radiolucent lines was significantly higher in the ATT group compared with the PFC group 12 months postoperatively (35.1%; n = 97 TKAs vs. 7.5%; n = 19 TKAs; p < 0.001). Survival analysis could not show any differences in revision-free survival or revision rate.ConclusionThe modern primary TKA system shows an increased number of radiolucent lines, especially on the tibial component in this short-term analysis and may mostly be due to technique-related issues. Patients with those radiolucent lines even though they show no clinical evidence for loosening should be closely monitored at regular intervals. These findings are of vital clinical importance because surgeons should be aware of particular challenges in preparation and cementing technique once they are using this TKA-system.Level of evidenceRetrospective cohort study, Level III.Electronic supplementary materialThe online version of this article (10.1007/s00167-018-5130-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Modern cemented total knee arthroplasty design shows a higher incidence of radiolucent lines compared to its predecessor

Staats

Wannmacher

Weihs

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…31 Final preparation of the bone-cement interface is best performed using pulsed lavage. In separate studies, Schlegel et al 32,33 confirmed the importance of bone preparation and pulsed lavage in enhancing fixation strength and recommended that it is a mandatory step in surface preparation along with copious drying of the tibial surface when cementing tibial components in TKA.…”

Section: Discussionmentioning

confidence: 99%

A potential need for surgeon consensus: Cementation techniques for total knee arthroplasty in orthopedic implant manufacturers’ guidelines lack consistency

Randall

Anderson

Gililland

et al. 2019

J Orthop Surg (Hong Kong)

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Aim: Given recent concerns regarding the influence of different cements and implants on the rate of aseptic failures in total knee arthroplasty (TKA), we wondered if cementation technique could play a role. The primary aim of this review was to collect and compare the surgeon education materials from eight orthopedic implant manufacturers to evaluate the manufacturers’ recommended cementation technique in TKA and identify if there was any consistency in these readily available guides as to the best practices of cementation of their implants. Materials and Methods: We reviewed contemporary surgeon education guidelines for all TKA systems available from eight manufacturers. Variables included: cement type, batches prepared, surface preparation prior to application, cleaning and/or drying the bone surface, mixing the cement, the waiting phase after the cement has been mixed prior to application, pressurizing the cement, location of cement application, and the curing time. Data were recorded and organized for qualitative comparisons. Results: We identified a total of 43 guides covering 38 implants from eight different manufacturers. There were 41 surgical technique guides and two general brochures regarding cementation techniques available from the manufacturers. Even within the manufacturers’ own guidelines for the different implants, there was a wide variety of differing guidelines on many aspects of the cementation technique. Conclusion: There is clearly no consensus for a preferred cementation technique both within and among manufacturers’ surgeon education materials regarding tibial baseplate cementation during TKA. Efforts may be needed to identify a best-practice cementation technique in an effort to reduce the number of TKA failures associated with aseptic loosening.

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“…Therefore, to obtain an optimal cement bone interface shear strength through interdigitation, a 3–5 mm cement penetration depth has been advised. Techniques using a spatula, finger pressing, and a cement gun have been suggested to improve penetration of cement into bone3,16,17). In contrast, the ideal thickness of cement mantle that bonds the prosthesis to the bone at the interface has been considered ≤1 mm12).…”

Section: Discussionmentioning

confidence: 99%

Cement Mantle Thickness at the Bone Cement Interface in Total Knee Arthroplasty: Comparison of PS150 RP and LPS-Flex Knee Implants

Ko¹,

Lee²,

Kim³

et al. 2017

Knee Surg Relat Res

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PurposeTo analyze the thickness of cement mantle at the bone cement interface in knees with closed and open box designs in total knee arthroplasty (TKA).Materials and MethodsEighty cases of TKA were performed from October 2013 to March 2014. The average age of the patients was 68.4 years. All patients were women and they were divided into two groups: group I with a closed box implant (PS150 RP, n=40) and group II with an open box implant (LPS-Flex, n=40). We measured the cement mantle thickness at the bone cement interface from the distal femur and proximal tibia. If the thickness was >1 mm, it was considered an outlier.ResultsThe mean cement mantle thickness at the interface was 1.4 mm in the distal femur and 0.8 mm in the proximal tibia. The value exceed 1 mm in 40 cases (50%) in the distal femur and in 6 cases (7.5%) in the proximal tibia (p<0.001). The mean cement mantle thickness measured in the distal femur was 1.7 mm in group I and 1.0 mm in group II. The value exceed 1 mm in 32 cases (80%) in group I and in 8 cases (20%) in group II (p<0.000).ConclusionsThe cement mantle at the interface was thicker in the knees with the closed box implant than those with the open box implant in TKA, especially in the distal femoral area. A thick cement mantle at the interface should be avoided because it affects the gap balance. In case of using a closed box implant in TKA, cementing should be performed with extra care.

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Comparison of different cement application techniques for tibial component fixation in TKA

Cited by 41 publications

References 41 publications

Modern cemented total knee arthroplasty design shows a higher incidence of radiolucent lines compared to its predecessor

Modern cemented total knee arthroplasty design shows a higher incidence of radiolucent lines compared to its predecessor

A potential need for surgeon consensus: Cementation techniques for total knee arthroplasty in orthopedic implant manufacturers’ guidelines lack consistency

Cement Mantle Thickness at the Bone Cement Interface in Total Knee Arthroplasty: Comparison of PS150 RP and LPS-Flex Knee Implants

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