Cementing the Tibial Component in Total Knee Arthroplasty

Vanlommel, Jan; Luyckx, Jean Philippe; Labey, Luc; Innocenti, Bernardo; Corte, Ronny De; Bellemans, Johan

doi:10.1016/j.arth.2010.01.107

Cited by 133 publications

(98 citation statements)

References 12 publications

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“…In a clinical study, PL and gun cementing resulted in mean bone cement penetration depths of 5 mm [13]. In an artificial bone model (Sawbone), similar mean penetration depths of 5 mm were reported when pressurizing cement [20]. Those penetration depths seem considerably higher when compared with the values in our study.…”

Section: Discussioncontrasting

confidence: 44%

An in vitro comparison of tibial tray cementation using gun pressurization or pulsed lavage

Schlegel

Püschel

Morlock

et al. 2014

International Orthopaedics (SICOT)

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Purpose Aseptic loosening of the tibial component remains a limitation to the highly successful procedure of total knee arthroplasty (TKA). Pulsed lavage improves bone cement penetration and interface strength in tibial tray cementation. This study tested whether pressurized cement application with a cement gun can compensate the use of jet lavage for bone surface preparation. Methods Tibial components were implanted in six pairs of cadaveric tibiae. On one side, pulsed lavage of the tibial bone was combined with finger packing of bone cement; on the other side, syringe lavage and gun cementing was used. Cement penetration into the bone was determined from computed tomography scans, and Interface strength was determined by pull-out testing. Results Cement penetration was greater (p=0.004) and interface strength was higher (p=0.028) in the pulsed lavage group. Conclusion Pressurization of cement by gun application could not compensate for the omission of pulsed lavage. Thus, pulsed lavage should be considered a crucial factor in TKA to improve implant fixation, which cannot be compensated for by cement application technique.

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Section: Discussioncontrasting

confidence: 44%

An in vitro comparison of tibial tray cementation using gun pressurization or pulsed lavage

Schlegel

Püschel

Morlock

et al. 2014

International Orthopaedics (SICOT)

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“…This method was shown to achieve less cement penetration in comparison to pressurisation techniques using a syringe or gun [15,18]. However, other investigations described either only minor improvement of intrusion depths or overpenetration (> 5 mm) when using cement pressurisation [14,30]. Though, penetration depths exceeding 5 mm might lead to thermal necrosis and thus early weakening of the resulting interface [11].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, definition of the "ideal cement penetration" in TKA is still controversial, e.g. while some studies recommended a minimal interdigitation depth of 4 mm, others deemed a range from 3-5 mm as acceptable [18,[29][30][31]. Generally, a minimum penetration of 2-3 mm has been suggested to engage at least one layer of transverse trabeculae and thus improve resistance to shear and tensile forces [31].…”

Section: Discussionmentioning

confidence: 99%

Pulsed lavage improves fixation strength of cemented tibial components

Schlegel

Siewe

Delank

et al. 2010

International Orthopaedics (SICOT)

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Pulsatile lavage is purported to improve radiographic survival in cemented total knee arthroplasty (TKA). Similarly, a potential improvement of fixation strength of the tibial tray has been assumed based on the increased cement penetration. In this study, the influence of pulsed lavage on fixation strength of the tibial component and bone cement penetration was evaluated in six pairs of cadaveric specimens. Following surgical preparation, the tibial surface was irrigated using pulsatile lavage on one side of a pair, while on the other side syringe lavage was applied. All tibial components were implanted using the same cementing technique. Cement penetration and bone mineral density was assessed based on computed tomography data. Fixation strength of the tibial trays was determined by a pull-out test with a material testing machine. Median pull-out forces and cement penetration were significantly (p=0.031) improved in the pulsed lavage group as compared to the syringe lavage group. Enhanced fixation strength is suggested as being a key to improved survival of the implant. Consequently, pulsatile lavage should be considered as a mandatory preparation step when cementing tibial components in TKA.

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“…Um die Knochenzementinterdigitation zu optimieren, bohren wir sklerotische Knochenoberflächen mit einem 2,0-mm-Bohrer an, reinigen die Oberflä-chen mit pulsierender CO 2 -oder Wasserlavage [11] und wählen eine doppelte Zementiertechnik auf Knochen und Implantat. Diese Strategie wird durch Daten aus der Knietotalprothetik gestützt [38], konnte bisher bei UKA jedoch keinen klaren Benefit zeigen [13]. Vor Zementierung der Komponenten platzieren wir eine Kompresse im posterioren Rezessus, um eine Zementprotrusion nach posterior zu verhindern.…”

Section: Zementieren Der Komponentenunclassified

Moderne unikondyläre Kniearthroplastik

Knoch

Munzinger

2014

Orthopäde

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Zusammenfassung Hintergrund Die unikondyläre Kniearthroplastik (UKA) ist bei fortgeschrittener medialer oder lateraler Gonarthrose eine etablierte Therapieoption. Ziel der Arbeit Die Eckpfeiler einer erfolgreichen UKA – sorgfältige Patientenselektion, präoperative Planung und präzise Operationstechnik – werden in dieser Übersichtsarbeit behandelt. Stellenwert Im Unterschied zur Knietotalarthroplastik erlaubt die UKA den Erhalt des kontralateralen und patellofemoralen Kompartiments sowie der Kreuzbänder und ist oft mit einer rascheren postoperativen Erholung, verbesserten Kniekinematik und Kniefunktion verbunden. Allerdings ist die UKA technisch sehr anspruchsvoll. Hohe Revisionsraten wurden v. a. bei breiter Anwendung gemäß nationaler Prothesenregister berichtet. Schlussfolgerung Der Erfolg der UKA hängt von einer sorgfältigen Patientenauswahl, detaillierten präoperativen Planung und Operationstechnik ab. Eine Erweiterung der klassischen Indikationskriterien für UKA halten wir für gerechtfertigt. Drei Typen der mechanischen Varus-Valgus-Deformität vor medialer oder lateraler UKA können unterschieden werden: Typ 1 (isolierte intraartikuläre Deformität), Typ 2 (übermäßige Deformität durch extraartikuläre Varusdeformität bei medialer UKA oder Valgusdeformität bei lateraler UKA), Typ 3 (reduzierte Deformität durch extraartikuläre Valgusdeformität bei medialer UKA oder Varusdeformität bei lateraler UKA). Diese Deformitäten sollten bei der Operationstechnik berücksichtigt werden.

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Cementing the Tibial Component in Total Knee Arthroplasty

Cited by 133 publications

References 12 publications

An in vitro comparison of tibial tray cementation using gun pressurization or pulsed lavage

An in vitro comparison of tibial tray cementation using gun pressurization or pulsed lavage

Pulsed lavage improves fixation strength of cemented tibial components

Moderne unikondyläre Kniearthroplastik

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