Wilson Jacob M, Mika Aleksander P, Gilbert William W, Mason J Bohannon, Polkowski Gregory G, Martin J Ryan
Department of Orthopedic Surgery, Emory University, Atlanta, GA, USA.
Department of Orthopedic Surgery, Vanderbilt University, Nashville, TN, USA.
Arthroplast Today. 2024 Dec 7;30:101574. doi: 10.1016/j.artd.2024.101574. eCollection 2024 Dec.
Aseptic loosening is the most common aseptic failure modality following total knee arthroplasty. Recent literature suggests that the implant-cement interface is the "weak-link" in fixation and lipid contamination may drive this debonding pattern. Therefore, the purpose of this study was to determine if the "double-butter" technique would significantly decrease lipid contamination of the tibial tray.
Transparent acrylic models of 7 different tibial baseplates were created to allow for direct visualization of fluid contamination of the implant-cement interface during experimental cementation. Three cementation techniques were then employed in triplicate for each implant: coating only the tibia ("single butter") and coating of the tibia and baseplate (with and without keel included; "double-butter"). A dye was added centrally to simulate lipid contamination. After each trial, the degree of implant-cement contamination was calculated. Standard statistical analyses were conducted.
With the double-butter technique, there was a significant reduction in contamination for all studied implant designs (range: 0%-7%; < .05) and contamination was eliminated when the entire implant was coated prior to implantation. The single-butter technique resulted in contamination of 16%-43% of the tibial undersurface. There were significant differences in percent contamination between component designs ( < .05).
Cementation technique and implant design each influenced baseplate lipid contamination. While significant differences were noted between keel geometries, we found that the double-butter technique effectively eliminated baseplate contamination, even in the most susceptible designs in this study. We therefore advocate for the incorporation of the double-butter technique to limit lipid contamination and potentially reduce aseptic tibial loosening.
无菌性松动是全膝关节置换术后最常见的无菌性失败形式。近期文献表明，植入物与骨水泥的界面是固定中的“薄弱环节”，脂质污染可能导致这种脱粘模式。因此，本研究的目的是确定“双涂”技术是否能显著减少胫骨托的脂质污染。
制作了7种不同胫骨基板的透明丙烯酸模型，以便在实验性骨水泥固定过程中直接观察植入物与骨水泥界面的液体污染情况。然后对每个植入物一式三份采用三种骨水泥固定技术：仅涂覆胫骨（“单涂”）以及涂覆胫骨和基板（包括或不包括龙骨；“双涂”）。在中心添加一种染料以模拟脂质污染。每次试验后，计算植入物与骨水泥的污染程度。进行标准统计分析。
采用双涂技术时，所有研究的植入物设计的污染均显著减少（范围：0% - 7%；P <.05），并且在植入前对整个植入物进行涂覆时污染被消除。单涂技术导致胫骨下表面16% - 43%被污染。组件设计之间的污染百分比存在显著差异（P <.05）。
骨水泥固定技术和植入物设计均影响基板脂质污染。虽然在龙骨几何形状之间存在显著差异，但我们发现双涂技术有效地消除了基板污染，即使在本研究中最易受影响的设计中也是如此。因此，我们主张采用双涂技术来限制脂质污染并可能减少无菌性胫骨松动。
