Effect of lavage and brush preparation on cement penetration and primary stability in tibial unicompartmental total knee arthroplasty: An experimental cadaver study

Scheele, Christian; Pietschmann, Matthias F.; Schröder, Christian; Grupp, Thomas M.; Holderied, M.; Jansson, V.; Müller, Peter E.

doi:10.1016/j.knee.2016.09.015

Cited by 13 publications

(15 citation statements)

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“…2016, Scheele et al. 2017). One study found no difference between pulsatile lavage and cleaning with a surgical brush comparing cement penetration and a mechanical compression test using a UKA model (Scheele et al.…”

Section: Resultsmentioning

confidence: 99%

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Cementing technique for primary knee arthroplasty: a scoping review

et al. 2019

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Background and purpose — The optimal cementing technique for primary total knee arthroplasty (TKA) remains unclear. We therefore performed a scoping review based on available studies regarding cementation technique in primary TKA and unicondylar knee arthroplasty (UKA).Patients and methods — A search in 3 databases identified 1,554 studies. The inclusion criteria were literature that studied cementing technique in primary TKA or UKA. This included cement application methods, full or surface cementing, applying cement to the bone and/or prosthesis, stabilization of the implant during curing phase, bone irrigation technique, drilling holes in the bone, use of suction, and the timing of cementation. 57 studies met the inclusion criteria.Results — The evidence was unanimously in favor of pulsatile lavage irrigation, drying the bone, and drilling holes into the tibia during a TKA. All studies concerning suction recommended it during TKA cementation. 7 out of 11 studies favored the use of a cement gun and no studies showed that finger packing was statistically significantly better than using a cement gun. There is evidence that full cementation should be used if metal-backed tibial components are used. Applying the cement to both implant and bone seems to give better cement penetration.Interpretation — There are still many knowledge gaps regarding cementing technique in primary TKA. There seems to be sufficient evidence to recommend pulsatile lavage irrigation of the bone, drilling multiple holes, and drying the bone before cementing and implant insertion, and applying cement to both implant and on the bone.

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Section: Resultsmentioning

confidence: 99%

“…One study found no difference between pulsatile lavage and cleaning with a surgical brush comparing cement penetration and a mechanical compression test using a UKA model (Scheele et al. 2017). 1 study found cleaning with pressurized CO2 in addition to pulsatile lavage to be significantly better than pulsatile lavage alone (Boontanapibul et al.…”

Section: Resultsmentioning

confidence: 99%

Cementing technique for primary knee arthroplasty: a scoping review

et al. 2019

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“…Common clinical practice in cementing UKA is to finger pack bone cement on the prosthesis only. However, former studies using single-layer technique show only limited cement penetration in knee arthroplasty [9, 14, 17]. In particular, a solid fixation in the posterior aspect of the joint seems to be difficult to achieve via a minimally invasive medial approach [13].…”

Section: Discussionmentioning

confidence: 99%

Impact of a double-layer cementing technique on the homogeneity of cementation and the generation of loose bone cement fragments in tibial unicompartmental knee arthroplasty

Scheele

Pietschmann

Schröder

et al. 2019

BMC Musculoskelet Disord

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BackgroundThe objective of this study was to evaluate the impact of a single- vs. double-layer cementing technique on morphological cementation and the generation of microscopic cement layers or loose cement fragments in unicompartmental knee arthroplasty (UKA).MethodsUKAs were implanted in 12 cadaver knees. The specimens were divided into two groups of comparable bone mineral density. Six UKAs were implanted using a single-layer cementing technique (group A) and six UKAs were implanted using a double-layer cementing technique (group B). Morphological cementation was assessed on nine cuts through the implant–cement–bone interface in the frontal plane. Loose bone cement fragments and the microscopically quality of layer formation were evaluated.ResultsContact between bone and prosthesis was observed in 45.4% of interfaces in group A and 27.8% in group B (p = 0.126). The significant increase of areas without visible cement interlocking in the anteroposterior direction in group A (p = 0.005) was not evident in group B (p = 0.262). Penetration around the peg tended to occur more frequently in group B (67.5% vs. 90.6% p = 0.091). Scanning electron microscopy identified no evidence of fissure formations within the bilaminar cement mantle. Free bone cement fragments were documented in 66.7% in both groups with no difference concerning mass (p = 1.0).ConclusionsThis in-vitro study showed a tendency towards a more homogenous cementation of tibial UKAs using a double-layer cementing technique, although most of the differences did not reach the level of significance. However, theoretical downsides of the double-layer cementing technique such as an increased formation of free bone fragments or a microscopically fissure formation within the cement layer could not be detected either.

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“…9 Penelitian yang sama oleh Schele dkk, menemukan bahwa tidak ada perbedaan statistik baik dalam kadar trigliserida atau kolesterol pada tindakan pemberian semen setelah lavage dibandingkan dengan hanya pemberian semen saja,. 19 Walaupun demikian hasil ini belum dapat menyangkal teori yang menyebutkan bahwa kilomikron plasma yang diaglutinasi merupakan sumber kemungkinan emboli lemak dan keberadaan suatu zat yang mengurangi stabilitas emulsi lemak plasma. 9,20 Oleh karena itu, penelitian yang lebih spesifik untuk menjawab hipotesis tersebut perlu dilakukan.…”

Section: Rerata Kelompok Intervensi (Sd)unclassified

Flushing intramedular dengan epinefrin pada prosedur Cemented Hip Arthroplasty menstabilkan mean arterial pressure tanpa mempengaruhi profil lipid

Aakash¹,

Kawiyana²,

Dusak³

et al. 2020

Intisari Sains Medis

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Background: Cemented Hip Arthroplasty is the first choice of surgical treatment in fractures of neck femur and advanced hip osteoarthritis. Nevertheless, the complication, Bone Cement Implantation Syndrome can produce intra/postoperative mortality. The systemic effects of bone cement uses is hemodynamic disturbance and pulmonary embolism. These complications are thought due to the entry of semen particles into the systemic circulation caused by increased intramedullary pressure and local vasodilation. Intramedullary flushing with epinephrine after cement implantation is one of the interventions that is expected to reduce this impact. This study aims to determine the difference in hemodynamic effects and lipid profile in patients undergone flushing with epinephrine versus NaCl 0.9%.Methods: A cross-sectional study involving 30 patients who underwent Cemented Hip Arthroplasty, randomly divided into 2 groups. Surgical procedures differ only in the components used for intramedullary flushing, namely NaCl 0.9% (control) and epinephrine 1: 50000 (intervention). Vital signs are observed and recorded at minute 2,4,6,8, and 10 after cementation. Serial data were analyzed with repeated measures ANOVA. Lipid profile examination was performed before and 12 hours postoperatively and the results were analyzed with Wilcoxon-test.Results: The study observed a decreased of mean arterial pressure (MAP) in the control group after two minutes of cementation, and reached its lowest point in the sixth minute (p <0.05). In the intervention group, the decrease occurred in second to sixth minutes, but the decrease was more stable and there was no significant difference between time-point (p> 0.05). There were no significant differences of triglyceride and cholesterol level before and 12 hours after the procedure (p> 0.05).Conclusion: Intramedullary flushing with epinephrine after semen implantation in the Cemented Hip Arthroplasty procedure results in a minimal reduction of MAP compared to flushing without epinephrine. However, there were no difference in preoperative and postoperative cholesterol and triglyceride levels.Latar Belakang: Cemented Hip Arthroplasty menjadi pilihan utama terapi pembedahan pada fraktur collum femoris (Neck of Femur) serta osteoarthritis sendi panggul stadium lanjut. Meskipun demikian, komplikasi Bone cement implantation syndrome dapat menghasilkan morbiditas dan mortalitas intra/pasca operasi. Efek sistemik dari penggunaan semen tulang adalah gangguan hemodinamik dan emboli paru yang diduga akibat masuknya dari partikel semen ke sirkulasi sistemik akibat peningkatan tekanan intrameduler dan vasodilatasi lokal. Flushing intramedula dengan epinefrin paska implantasi semen merupakan salah satu intervensi yang diharapkan mengurangi dampak tersebut. Penelitian ini dilakukan untuk mengetahui perbedaan dampak hemodinamik dan profil lipid pada pasien dengan flushing epinefrine dan NaCl 0,9%.Metode: Penelitian potong lintang dengan melibatkan 30 pasien yang menjalani cemented arthroplasty, dibagi rata menjadi 2 kelompok secara acak. Prosedur pembedahan hanya berbeda pada komponen yang digunakan untuk flushing intramedula, yakni NaCl 0,9% (kontrol) dan epinefirn 1:50.000 (intervensi). Tanda vital diamati dan dicatat pada menit ke-2,4,6,8, dan 10 setelah sementasi. Data serial dianalisis dengan repeated measure Anova. Pemeriksaan profil lipid dilakukan sebelum dan 12 jam pasca operasi dan hasil dianalisis dengan Wilcoxon-test.Â Hasil: Penurunan mean arterial pressure (MAP) pada kelompok kontrol sejak menit ke 2 setelah sementasi, dan mencapai titik terendah pada menit ke 6 (p<0,05). Pada kelompok intervensi didapatkan penurunan terjadi pada menit ke 2 hingga ke 6, tetapi penurunan lebih stabil dan tidak terdapat perbedaan bermakna (p>0.05). Pada profil lipid (trigliserida dan kolesterol), tidak ditemukan perbedaan yang bermakna antara kadar sebelum operasi dan 12 jam setelah tindakan operatif (p>0,05).Kesimpulan: Flushing epinefrin paska implantasi semen pada prosedur Cemented Hip Arthroplasty menghasilkan penurunan MAP yang minimal dibandingkan flushing tanpa epinefrin. Akan tetapi, flushing epinefrin tidak memberikan perbedaan pada kadar kolesterol dan trigliserida paska operasi.

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Effect of lavage and brush preparation on cement penetration and primary stability in tibial unicompartmental total knee arthroplasty: An experimental cadaver study

Cited by 13 publications

References 37 publications

Cementing technique for primary knee arthroplasty: a scoping review

Cementing technique for primary knee arthroplasty: a scoping review

Impact of a double-layer cementing technique on the homogeneity of cementation and the generation of loose bone cement fragments in tibial unicompartmental knee arthroplasty

Flushing intramedular dengan epinefrin pada prosedur Cemented Hip Arthroplasty menstabilkan mean arterial pressure tanpa mempengaruhi profil lipid

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