Satish Bhava R J, Thadi Mohan, Thirumalaisamy Subbiahgounder, Sunil Apsingi, Basanagoudar Praveen L, Leo Bernard
Research performed at BRJ Orthocentre and MAK Hospital, Coimbatore, India.
BRJ Orthocentre and MAK Hospital, Eru Company Stop, Mettupalayam Road, Coimbatore, India.
Arch Bone Jt Surg. 2018 Sep;6(5):381-389.
No scientific evidence exists regarding the amount of bone cement used and discarded in primary cemented Total knee arthroplasty (TKA). The aim of this study was to identify the exact amount of bone cement utilized for component fixation in primary TKA.
In a prospective study carried out at five centers, 133 primary cemented TKAs were performed. One pack of 40g Palacos bone cement (PBC 40) was hand mixed and digitally applied during the surgery. After fixation of the TKA components, the remaining bone cement was methodically collected and weighed on a digital weighing scale. The actual quantity of cement utilized for component fixation was calculated.
On an average, 22.1 g of bone cement was utilized per joint, which accounted to 39 % of 57 g, the solidified dry weight of PBC 40. Among 133 knees, the cement usage was 20 % to 50% in 109 knees, more than 50% in 20 knees and less than 20% in 4 knees. Knees which received larger sized femoral implant required more cement compared to medium and small sizes. Knees which had pulse lavage had more cement utilization compared to knees which had simple syringe lavage before implantation.
Large quantity of bone cement was handled than actual requirements in primary TKA when a standard 40g pack was used with the digital application technique, resulting in sizeable discard of bone cement. Customizing cement pack according to the implant size can potentially avoid this cement wastage. Future research is required to study the utility and economic impact of smaller packs (20 g or 30 g) of bone cement in primary TKA.
关于初次骨水泥型全膝关节置换术（TKA）中使用和废弃的骨水泥量，尚无科学证据。本研究的目的是确定初次TKA中用于组件固定的骨水泥的确切用量。
在五个中心进行的一项前瞻性研究中，实施了133例初次骨水泥型TKA。手术过程中，手工混合一包40g的帕拉科斯骨水泥（PBC 40）并以数字方式应用。在TKA组件固定后，有系统地收集剩余的骨水泥，并在数字秤上称重。计算用于组件固定的骨水泥实际用量。
平均每个关节使用22.1g骨水泥，占PBC 40凝固干重57g的39%。在133个膝关节中，109个膝关节的骨水泥用量为20%至50%，20个膝关节超过50%，4个膝关节少于20%。与中、小号股骨植入物相比，接受大号股骨植入物的膝关节需要更多的骨水泥。与植入前使用简单注射器冲洗的膝关节相比，进行脉冲冲洗的膝关节骨水泥用量更多。
在初次TKA中，当使用标准40g包装并采用数字应用技术时，处理的骨水泥量超过实际需求，导致大量骨水泥被废弃。根据植入物尺寸定制骨水泥包装可能避免这种骨水泥浪费。未来需要研究较小包装（20g或30g）骨水泥在初次TKA中的效用和经济影响。
