The impact of tourniquet on tibial bone cement penetration in different zones in primary total knee arthroplasty: a meta-analysis

Abstract Background Cement mantle penetration and the cement–bone interface strength were critical to a successful primary total knee arthroplasty (TKA). It remained unclear whether decreased blood and fat in the cancellous bone achieved with the use of a tourniquet increases tibial cement mantle penetration in different zones on AP and lateral view in TKA according to criteria defined by the Knee Society Scoring System (KSS). The purpose of this study was to determine whether tourniquet use influences tibial cement mantle penetration in different zones on AP and lateral view in TKA according to KSS. Methods We conducted a meta-analysis to identify studies involving the impact of tourniquet use and no tourniquet use on tibial bone cement penetration in primary TKA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, VIP, Wanfang database, up to January 2021. Finally, we identified 1231 patients (1231 knees) assessed in twelve studies. Results Tourniquet use increases the cumulative cement mantle penetration (P < 0.00001), mean cement mantle penetration (P = 0.004), and cement mantle in zone 3(P < 0.0001) on AP view. However, there were no significant differences in cement mantle in zone 1(P = 0.5), zone 2(P =0 .54), zone 4(P = 0.07) on AP view, and zone 1(P = 0.32), zone 2(P = 0.38) on lateral view between two groups. There were also no significant differences in length of surgery(P = 0.7), change in hemoglobin(P = 0.4), transfusion rates(P = 0.47), and complications such as muscular calf vein thrombosis(P = 0.21), superficial infection (P = 0.72), and deep vein thrombosis (P = 0.66) between two groups. Conclusion The application of a tourniquet increases the thickness of the tibial bone cement penetration—the increase in the thickness of bone cement penetration mainly located in zone 3 on the anteroposterior (AP) view.

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Tourniquet application does not affect the periprosthetic bone cement penetration in total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-018-5330-7 ◽

2018 ◽

Vol 27 (7) ◽

pp. 2071-2081 ◽

Cited By ~ 7

Author(s):

Ahmed Jawhar ◽

Vera Stetzelberger ◽

Karl Kollowa ◽

Udo Obertacke

Keyword(s):

Total Knee Arthroplasty ◽

Bone Cement ◽

Knee Arthroplasty ◽

Periprosthetic Bone ◽

Cement Penetration ◽

Bone Cement Penetration ◽

Total Knee

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Bone cement penetration pattern and primary stability testing in keeled and pegged glenoid components

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2010.09.006 ◽

2011 ◽

Vol 20 (5) ◽

pp. 723-731 ◽

Cited By ~ 19

Author(s):

Patric Raiss ◽

Guido Pape ◽

Kerstin Kleinschmidt ◽

Sebastian Jäger ◽

Boris Sowa ◽

...

Keyword(s):

Bone Cement ◽

Primary Stability ◽

Stability Testing ◽

Cement Penetration ◽

Bone Cement Penetration

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Bone cement penetration of the acetabulum in total hip replacement

International Orthopaedics ◽

10.1007/s002640050085 ◽

1996 ◽

Vol 20 (5) ◽

pp. 315-320 ◽

Cited By ~ 4

Author(s):

K.-D. Heller ◽

A. Prescher ◽

M. Holbeck ◽

R. Forst

Keyword(s):

Bone Cement ◽

Total Hip Replacement ◽

Hip Replacement ◽

Total Hip ◽

Cement Penetration ◽

Bone Cement Penetration

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Damage of the Bone-Cement Interface in Finite Element Analyses of Cemented Orthopaedic Implants

Periodica Polytechnica Mechanical Engineering ◽

10.3311/ppme.11851 ◽

2018 ◽

Cited By ~ 1

Author(s):

Toufik Bousnane ◽

Smail Benbarek ◽

Abderahmen Sahli ◽

Boualem Serier ◽

Bel Abbes Bachir Bouiadjra

Keyword(s):

Bone Cement ◽

Load Transfer ◽

Cement Mantle ◽

Damage Scenario ◽

Cement Interface ◽

Total Hip ◽

Long Term Stability ◽

Prosthetic Implants ◽

Cement Penetration

In orthopedic surgery and particularly in total hip arthroplasty, fixation of femoral implant is generally made by the surgical cement. Bone–cement interface has long been implicated in failure of cemented total hip replacement (THA), it is actually a critical site that affect the long-term stability and survival of prosthetic implants after implantation. The main purpose of this study is to investigate the effect of cement penetration into the bone on damage scenario at the interface. Previously most researchers have been performed to study damage accumulation in the cement mantle for different amount of cement penetration. In this work, bone–cement interface integrity has been studied for different mechanical properties. Cohesive traction separation law is used to detect contact damage between cement and bone. Results showed that a larger debonded area was predicted proximally and distally. Adhesion between bone and cement is affected mainly by cement penetration into the bone. Higher cement penetration into the bone leads to a good load transfer. A lower strength of the bone–cement interface due to a lower mechanical property results in faster interface damage. So we advise surgeons to well perpetrate the bone for long-term durability of cemented THA.

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Anticoagulation and Transjugular Intrahepatic Portosystemic Shunting for Treatment of Portal Vein Thrombosis in Cirrhosis: A Systematic Review and Meta-Analysis

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619888026 ◽

2019 ◽

Vol 25 ◽

pp. 107602961988802

Author(s):

Jessica P. E. Davis ◽

Amy G. Ogurick ◽

Carrie E. Rothermel ◽

Min-Woong Sohn ◽

Nicolas M. Intagliata ◽

...

Keyword(s):

Portal Vein ◽

Observational Studies ◽

Meta Analysis ◽

Control Groups ◽

Hepatic Decompensation ◽

Vein Thrombosis ◽

Pooled Data ◽

Transjugular Intrahepatic Portosystemic Shunting ◽

Portosystemic Shunting ◽

The Impact

Portal vein thromboses (PVTs) are associated with hepatic decompensation, worse survival, and worse liver transplant outcomes. We evaluated the impact of anticoagulation (AC) and transjugular intrahepatic portosystemic shunting (TIPS) on recanalization and mortality in patients with cirrhosis and PVT. Systematic search of electronic databases was performed. Clinical trials and observational studies that evaluated primary outcomes of recanalization and survival in patients with cirrhosis having PVT treated with AC or TIPS were included. Risk of bias was assessed. Summary odds ratios (ORs) for pooled data from the included studies were generated using a random effects model. A total of 505 studies were screened for inclusion. After review, 7 studies were ultimately included. Data from 327 patients in total were evaluated. Overall, treatment with either AC or TIPS resulted in partial or complete recanalization (OR: 4.56 [95% confidence interval, CI: 2.46-8.47]) but did not significantly impact mortality (OR: 0.57 [95% CI: 0.21-1.57]). The summary OR of AC for recanalization was 6.00 (95% CI: 2.38-15.07). The summary OR of TIPS for recanalization was 3.80 (95% CI: 1.47-9.83). The summary OR of mortality in patients treated with AC for PVT was 0.28 (95% CI: 0.08-0.95). The mortality summary OR was 1.10 (95% CI 0.23-5.16) in patients who underwent TIPS. There was insufficient data to assess complications such as hepatic encephalopathy or bleeding. Both AC and TIPS have a significant effect on recanalization. Anticoagulation appears to have a protective effect on mortality that is not seen with TIPS. More studies with control groups are need.

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Evaluation of surgical technique of screws and bone cement in R and C tibial bone defects correction of primary Total Knee Arthroplasty

Journal of Intelligent & Fuzzy Systems ◽

10.3233/jifs-219023 ◽

2021 ◽

pp. 1-6

Author(s):

Shouye Hu ◽

Chao Lu ◽

Zhi Yang ◽

Kan Peng

Keyword(s):

Total Knee Arthroplasty ◽

Surgical Technique ◽

Bone Cement ◽

Knee Arthroplasty ◽

Primary Total Knee Arthroplasty ◽

Bone Defects ◽

Tibial Bone ◽

Total Knee ◽

Primary Total Knee

Objective: The use of screws and cement is a well–known technique for repairing proximal tibial bone defects during primary total knee arthroplasty (TKA). The purpose of this study was to summarize our experience of using of screws and cement for R and C tibial bone defects in primary TKA.

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Lack of Efficacy of Prophylactic Application of Antibiotic-Loaded Bone Cement for Prevention of Infection in Primary Total Knee Arthroplasty: Results of a Meta-Analysis

Surgical Infections ◽

10.1089/sur.2014.044 ◽

2015 ◽

Vol 16 (2) ◽

pp. 183-187 ◽

Cited By ~ 17

Author(s):

Yiqin Zhou ◽

Lintao Li ◽

Qi Zhou ◽

Shuai Yuan ◽

Yuli Wu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Bone Cement ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Primary Total Knee Arthroplasty ◽

Prevention Of Infection ◽

Total Knee ◽

Primary Total Knee

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Improving the cementation of the tibial component in knee arthroplasty

Bone and Joint Research ◽

10.1302/2046-3758.108.bjr-2020-0524.r1 ◽

2021 ◽

Vol 10 (8) ◽

pp. 467-473

Author(s):

Juan Ramón Rodríguez-Collell ◽

Damian Mifsut ◽

Amparo Ruiz-Sauri ◽

Luis Rodríguez-Pino ◽

Eva María González-Soler ◽

...

Keyword(s):

Bone Cement ◽

Layer Thickness ◽

Double Layer ◽

Knee Arthroplasty ◽

Tibial Component ◽

The Other ◽

Tibial Tray ◽

Tibial Bone ◽

Cement Penetration ◽

Cement Restrictor

Aims The main objective of this study is to analyze the penetration of bone cement in four different full cementation techniques of the tibial tray. Methods In order to determine the best tibial tray cementation technique, we applied cement to 40 cryopreserved donor tibiae by four different techniques: 1) double-layer cementation of the tibial component and tibial bone with bone restrictor; 2) metallic cementation of the tibial component without bone restrictor; 3) bone cementation of the tibia with bone restrictor; and 4) superficial bone cementation of the tibia and metallic keel cementation of the tibial component without bone restrictor. We performed CT exams of all 40 subjects, and measured cement layer thickness at both levels of the resected surface of the epiphysis and the endomedular metaphyseal level. Results At the epiphyseal level, Technique 2 gave the greatest depth compared to the other investigated techniques. At the endomedular metaphyseal level, Technique 1 showed greater cement penetration than the other techniques. Conclusion The best metaphyseal cementation technique of the tibial component is bone cementation with cement restrictor. Additionally, if full tibial component cementation is to be done, the cement volume used should be about 40 g of cement, and not the usual 20 g. Cite this article: Bone Joint Res 2021;10(8):467–473.

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