Schmicker Thomas L, Goel Akshay, Davis Sarah, Sina Adil Syed Ali, Oliashirazi Ali, Bullock Matthew
Department of Orthopaedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA.
Snøhetta, New York, NY, USA.
Arthroplast Today. 2022 Jul 9;16:197-202. doi: 10.1016/j.artd.2022.04.011. eCollection 2022 Aug.
Aseptic loosening of the cemented tibial component is a source of failure in total knee arthroplasty. This study examined common techniques for cement application by quantifying depth and volume of penetration into tibia models.
Thirty-six composite tibia models were cemented with a tibial component using 3 application techniques (gun, osteotome, and layered) with either early or late cement working time. Computed tomography and 3D-modeling were used to quantify volume and depth of penetration. Statistical analysis was conducted with analysis of variance with Bonferroni correction and Student's -test.
No difference was found in overall volume of penetration between early and late cement application ( = .16). Beneath the baseplate, the layered technique had significantly less penetration and averaged less than 3 mm with early and late cement. The gun technique had the greatest depth of penetration with early cement and averaged greater than 3 mm in all zones regardless of cement working time. The osteotome technique achieved significantly greater depth of penetration around the keel with early and late cement, < .01.
Using a cement gun ensures adequate penetration beneath the baseplate regardless of cement working time while the osteotome technique is effective to increase penetration around the implant keel. According to our study, applying cement early in its working time may not increase volume of penetration. This study raises concern regarding adequate cement penetration using the layered technique for cementing the tibial component in total knee arthroplasty, and future research is warranted.
骨水泥固定型胫骨假体的无菌性松动是全膝关节置换术失败的一个原因。本研究通过量化骨水泥渗入胫骨模型的深度和体积，对常用的骨水泥应用技术进行了研究。
采用3种应用技术（喷枪、骨刀和分层），在骨水泥凝固早期或晚期，将36个复合胫骨模型与胫骨假体进行骨水泥固定。使用计算机断层扫描和三维建模来量化渗入的体积和深度。采用方差分析并进行Bonferroni校正和Student's检验进行统计分析。
骨水泥凝固早期和晚期的总体渗入体积无差异（P = 0.16）。在基板下方，分层技术的渗入明显较少，骨水泥凝固早期和晚期的平均渗入深度均小于3mm。喷枪技术在骨水泥凝固早期的渗入深度最大，无论骨水泥凝固时间如何，在所有区域的平均渗入深度均大于3mm。骨刀技术在骨水泥凝固早期和晚期在龙骨周围的渗入深度均显著更大，P < 0.01。
使用骨水泥喷枪可确保在基板下方有足够的渗入，无论骨水泥凝固时间如何，而骨刀技术可有效增加植入物龙骨周围的渗入。根据我们的研究，在骨水泥凝固早期应用骨水泥可能不会增加渗入体积。本研究引发了对在全膝关节置换术中使用分层技术固定胫骨假体时骨水泥充分渗入的担忧，未来有必要进行研究。
