Download PDF
J Knee Surg 2019; 32(09): 886-890
DOI: 10.1055/s-0038-1669917
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparing Cementing Techniques in Total Knee Arthroplasty: An In Vitro Study

Thomas Wetzels
1   Department of Orthopedic Surgery, Martini Ziekenhuis, Groningen, The Netherlands
2   Department of Orthopaedics, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
,
Joost van Erp
1   Department of Orthopedic Surgery, Martini Ziekenhuis, Groningen, The Netherlands
,
Reinoud W. Brouwer
1   Department of Orthopedic Surgery, Martini Ziekenhuis, Groningen, The Netherlands
,
Sjoerd K. Bulstra
2   Department of Orthopaedics, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
,
Jos J. A. M. van Raay
1   Department of Orthopedic Surgery, Martini Ziekenhuis, Groningen, The Netherlands
› Author Affiliations
Further Information

Publication History

17 January 2018

27 July 2018

Publication Date:
06 September 2018 (online)

    Permissions and Reprints

Abstract

Aseptic loosening remains to be a major reason for revision in total knee arthroplasty. Cement penetration of 2 to 5 mm increases the interface strength and consequently decreases the likelihood of loosening. But despite this overall accepted optimal cement penetration, there is still a wide variety of cementing techniques used in total knee arthroplasty. The purpose of this study was to evaluate two cementing techniques on the tibial and femoral sides, with regard to cement penetration. Five paired cadaveric knees were used. A total knee arthroplasty was placed according to standard practice, with a setup that mimics the clinical practice. On the tibial side, we compared the application of cement to the bone surface alone, to the application of cement to both the bone surface and the component. On the femoral side, we compared the application of cement to the posterior condyles of the component and to the anterior and distal parts of the bone surface, to the application of cement to the component alone. After the cement had cured, the arthroplasty was removed and the bone was examined to determine the cement penetration using digital software. When applying cement to both the tibial bone surface and the tibial component, the cement penetration increased compared with applying cement to the tibial bone surface alone (3.46 vs. 2.66 mm, p = 0.007). With regard to the distal femoral cuts, the cement penetration did not vary when applied to either the bone or the component (2.81 vs. 2.91 mm). But applying it to the anterior bone surface did seem preferable, when compared with only applying it to the component. The average cement penetration did not differ, but applying the cement to the bone did enlarge the total length of the cement distribution (2.48 vs. 0.96 mm, p = 0.011). Almost no cement was detected on the posterior surface of the femoral cut. We concluded that applying cement to both the tibial bone surface and the component improves cement penetration.

Keywords

total knee arthroplasty - cement - fixation - cement penetration - cementing techniques
 

  • References

  • 1 Bozic KJ, Kurtz SM, Lau E. , et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010; 468 (01) 45-51
    CrossrefPubMedSearch in Google Scholar
  • 2 Sharkey PF, Lichstein PM, Shen C, Tokarski AT, Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years?. J Arthroplasty 2014; 29 (09) 1774-1778
    CrossrefPubMedSearch in Google Scholar
  • 3 Sundfeldt M, Carlsson LV, Johansson CB, Thomsen P, Gretzer C. Aseptic loosening, not only a question of wear: a review of different theories. Acta Orthop 2006; 77 (02) 177-197
    CrossrefPubMedSearch in Google Scholar
  • 4 Miller MA, Terbush MJ, Goodheart JR, Izant TH, Mann KA. Increased initial cement-bone interlock correlates with reduced total knee arthroplasty micro-motion following in vivo service. J Biomech 2014; 47 (10) 2460-2466
    CrossrefPubMedSearch in Google Scholar
  • 5 Walker PS, Soudry M, Ewald FC, McVickar H. Control of cement penetration in total knee arthroplasty. Clin Orthop Relat Res 1984; (185) 155-164
    PubMedSearch in Google Scholar
  • 6 Gebert de Uhlenbrock A, Püschel V, Püschel K, Morlock MM, Bishop NE. Influence of time in-situ and implant type on fixation strength of cemented tibial trays - a post mortem retrieval analysis. Clin Biomech (Bristol, Avon) 2012; 27 (09) 929-935
    CrossrefPubMedSearch in Google Scholar
  • 7 MacDonald W, Swarts E, Beaver R. Penetration and shear strength of cement-bone interfaces in vivo. Clin Orthop Relat Res 1993; (286) 283-288
    PubMedSearch in Google Scholar
  • 8 Miller MA, Goodheart JR, Izant TH, Rimnac CM, Cleary RJ, Mann KA. Loss of cement-bone interlock in retrieved tibial components from total knee arthroplasties. Clin Orthop Relat Res 2014; 472 (01) 304-313
    CrossrefPubMedSearch in Google Scholar
  • 9 Cawley DT, Kelly N, McGarry JP, Shannon FJ. Cementing techniques for the tibial component in primary total knee replacement. Bone Joint J 2013; 95-B (03) 295-300
    CrossrefPubMedSearch in Google Scholar
  • 10 Berman AT, Reid JS, Yanicko Jr DR, Sih GC, Zimmerman MR. Thermally induced bone necrosis in rabbits. Relation to implant failure in humans. Clin Orthop Relat Res 1984; (186) 284-292
    PubMedSearch in Google Scholar
  • 11 Mjöberg B, Pettersson H, Rosenqvist R, Rydholm A. Bone cement, thermal injury and the radiolucent zone. Acta Orthop Scand 1984; 55 (06) 597-600
    CrossrefPubMedSearch in Google Scholar
  • 12 Sih GC, Connelly GM, Berman AT. The effect of thickness and pressure on the curing of PMMA bone cement for the total hip joint replacement. J Biomech 1980; 13 (04) 347-352
    CrossrefPubMedSearch in Google Scholar
  • 13 Boner V, Kuhn P, Mendel T, Gisep A. Temperature evaluation during PMMA screw augmentation in osteoporotic bone--an in vitro study about the risk of thermal necrosis in human femoral heads. J Biomed Mater Res B Appl Biomater 2009; 90 (02) 842-848
    PubMedSearch in Google Scholar
  • 14 Huiskes R. Some fundamental aspects of Human Joint Replacement: Analyses of Stresses and Heat Conduction in Bone-Prosthesis Structures. Acta Orthop Scand 1980; 51 (185) 3-208
    CrossrefPubMedSearch in Google Scholar
  • 15 Schlegel UJ, Püschel K, Morlock MM, Nagel K. An in vitro comparison of tibial tray cementation using gun pressurization or pulsed lavage. Int Orthop 2014; 38 (05) 967-971
    CrossrefPubMedSearch in Google Scholar
  • 16 Norton MR, Eyres KS. Irrigation and suction technique to ensure reliable cement penetration for total knee arthroplasty. J Arthroplasty 2000; 15 (04) 468-474
    CrossrefPubMedSearch in Google Scholar
  • 17 Seeger JB, Jaeger S, Bitsch RG, Mohr G, Röhner E, Clarius M. The effect of bone lavage on femoral cement penetration and interface temperature during Oxford unicompartmental knee arthroplasty with cement. J Bone Joint Surg Am 2013; 95 (01) 48-53
    CrossrefPubMedSearch in Google Scholar
  • 18 Banwart JC, McQueen DA, Friis EA, Graber CD. Negative pressure intrusion cementing technique for total knee arthroplasty. J Arthroplasty 2000; 15 (03) 360-367
    CrossrefPubMedSearch in Google Scholar
  • 19 Lutz MJ, Pincus PF, Whitehouse SL, Halliday BR. The effect of cement gun and cement syringe use on the tibial cement mantle in total knee arthroplasty. J Arthroplasty 2009; 24 (03) 461-467
    CrossrefPubMedSearch in Google Scholar
  • 20 Krause WR, Krug W, Miller J. Strength of the cement-bone interface. Clin Orthop Relat Res 1982; (163) 290-299
    PubMedSearch in Google Scholar
  • 21 Lutz MJ, Halliday BR. Survey of current cementing techniques in total knee replacement. ANZ J Surg 2002; 72 (06) 437-439
    CrossrefPubMedSearch in Google Scholar
  • 22 Vanlommel J, Luyckx JP, Labey L, Innocenti B, De Corte R, Bellemans J. Cementing the tibial component in total knee arthroplasty: which technique is the best?. J Arthroplasty 2011; 26 (03) 492-496
    CrossrefPubMedSearch in Google Scholar
  • 23 Vaninbroukx M, Labey L, Innocenti B, Bellemans J. Cementing the femoral component in total knee arthroplasty: which technique is the best?. Knee 2009; 16 (04) 265-268
    CrossrefPubMedSearch in Google Scholar
  • 24 Labutti RS, Bayers-Thering M, Krackow KA. Enhancing femoral cement fixation in total knee arthroplasty. J Arthroplasty 2003; 18 (08) 979-983
    CrossrefPubMedSearch in Google Scholar