1
|
Refsum AM, Nguyen UV, Gjertsen JE, Espehaug B, Fenstad AM, Lein RK, Ellison P, Høl PJ, Furnes O. Cementing technique for primary knee arthroplasty: a scoping review. Acta Orthop 2019; 90:582-589. [PMID: 31452416 PMCID: PMC6844414 DOI: 10.1080/17453674.2019.1657333] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Anders M Refsum
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen;
| | - Uy V Nguyen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen;
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; ,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Birgitte Espehaug
- Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen;
| | - Anne M Fenstad
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Regina K Lein
- Medical Library, University of Bergen, Bergen, Norway
| | - Peter Ellison
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Paul J Høl
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; ,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Ove Furnes
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; ,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Correspondence:
| |
Collapse
|
2
|
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:295-300. [PMID: 23450010 DOI: 10.1302/0301-620x.95b3.29586] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The optimum cementing technique for the tibial component in cemented primary total knee replacement (TKR) remains controversial. The technique of cementing, the volume of cement and the penetration are largely dependent on the operator, and hence large variations can occur. Clinical, experimental and computational studies have been performed, with conflicting results. Early implant migration is an indication of loosening. Aseptic loosening is the most common cause of failure in primary TKR and is the product of several factors. Sufficient penetration of cement has been shown to increase implant stability. This review discusses the relevant literature regarding all aspects of the cementing of the tibial component at primary TKR.
Collapse
Affiliation(s)
- D T Cawley
- Merlin Park Hospital, Department of Trauma & Orthopaedic Surgery, Galway, Ireland.
| | | | | | | |
Collapse
|