The Effect of Viscosity on Cement Penetration in Total Knee Arthroplasty, an Application of the Squeeze Film Effect

AbstractAseptic 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.

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Intraoperative tibial plateau fracture during bone preparation in a cruciate retaining primary total knee arthroplasty

BMJ Case Reports ◽

10.1136/bcr-2019-233826 ◽

2020 ◽

Vol 13 (9) ◽

pp. e233826

Author(s):

Shea K Taylor ◽

Andrew Sephian ◽

Timothy Clader

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Rare Complication ◽

Primary Total Knee Arthroplasty ◽

Medial Tibial Plateau ◽

Cement Penetration ◽

Plateau Fracture ◽

Total Knee

Intraoperative fractures are a rare complication in total knee arthroplasty. Limited literature exists in regard to the incidence, mechanism of injury and management of intraoperative fractures. The authors report a unique case of an 80-year-old man who sustained a medial tibial plateau fracture that occurred intraoperatively during final tibia bone preparation with the use of the Woolley Tibia Punch (Innomed, Savannah, Georgia, USA). The fracture was managed with the addition of 4.5 mm cortical lag screws and the addition of a stemmed tibial implant to bypass the fracture. This is the first reported case in literature that describes an intraoperative medial tibial plateau that occurred through the use of a Woolley Tibia Punch. The authors recommend the consideration of drilling to prepare sclerotic bone for cement penetration rather than a punch in order to minimise the potential for intraoperative fractures that may occur with the use of a punch.

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