Vertullo Christopher J, Zbrojkiewicz David, Vizesi Frank, Walsh William R
Knee Research Australia, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute, Griffith University, Gold Coast, Australia.
Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, UNSW Australia, Randwick, New South Wales, Australia.
Open Orthop J. 2016 Mar 22;10:19-25. doi: 10.2174/1874325001610010019. eCollection 2016.
The major cause of cemented Total Knee Arthroplasty (TKA) failure is aseptic loosening of the tibial component necessitating revision surgery. Recently, multiple techniques have been described to maximize cement penetration depth and density in the proximal tibia during TKA to potentially avoid early loosening. While cement polymerisation is an exothermic reaction, minimal investigation into the proximal tibial thermal safety margin during cement polymerisation has been undertaken. In animal models osseous injury occurs at temperatures greater than 47 °C when applied for one minute. The aim of this study was to investigate the cement bone interface temperatures in TKA using modern tibial cementing techniques with a cadaveric tibial tray model.
Eight adult cadavers were obtained with the proximal tibial surface prepared by a fellowship trained arthroplasty surgeon. Third generation cementation techniques were used and temperatures during cement polymerization on cadaveric knee arthroplasty models were recorded using thermocouples.
The results showed that no tibial cement temperature exceeded 44 °C for more than 1 minute. Two of the eight cadaveric tibias recorded maximum temperatures greater than 44 °C for 55 seconds and 33 seconds, just less than the 60 seconds reported to cause thermal injury. Average maximum polymerization temperatures did not correlate with deeper cement penetration or tray material. Maximum mantle temperatures were not statistically different between metal and all polyethylene tibial trays.
Our investigation suggests that modern cementing techniques result in maximum mantle temperatures that are less than previously recorded temperatures required to cause thermal osseous injury, although this thermal injury safety margin is quite narrow at an average of 4.95 °C (95% confidence interval ± 4.31).
骨水泥型全膝关节置换术（TKA）失败的主要原因是胫骨部件无菌性松动，这需要进行翻修手术。最近，已有多种技术被描述用于在TKA过程中最大化骨水泥在胫骨近端的渗透深度和密度，以潜在地避免早期松动。虽然骨水泥聚合是一个放热反应，但对于骨水泥聚合过程中胫骨近端热安全边际的研究却很少。在动物模型中，当施加一分钟时，温度高于47°C会发生骨损伤。本研究的目的是使用现代胫骨骨水泥技术和尸体胫骨托盘模型，研究TKA中骨水泥-骨界面的温度。
获取八具成年尸体，其胫骨近端表面由接受过专科培训的关节置换外科医生进行制备。使用第三代骨水泥技术，并使用热电偶记录尸体膝关节置换模型中骨水泥聚合过程中的温度。
结果显示，没有胫骨骨水泥温度超过44°C超过1分钟。八具尸体胫骨中有两具记录的最高温度分别为44°C以上55秒和33秒，略低于据报道会导致热损伤的60秒。平均最高聚合温度与更深的骨水泥渗透或托盘材料无关。金属和全聚乙烯胫骨托盘之间的最大套层温度没有统计学差异。
我们的研究表明，现代骨水泥技术导致的最大套层温度低于先前记录的导致热骨损伤所需的温度，尽管这个热损伤安全边际相当窄，平均为4.95°C（95%置信区间±4.31）。
