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Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Influence of the fixing technique on the quality of the cement mantle in knee ar...
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Vol. 55. Núm. 1.
Páginas 39-49 (enero - febrero 2011)
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Vol. 55. Núm. 1.
Páginas 39-49 (enero - febrero 2011)
Investigation
Acceso a texto completo
Influence of the fixing technique on the quality of the cement mantle in knee arthroplasty. Experimental study on a synthetic model
Influencia de la técnica de cementación sobre la calidad del manto de cemento en la artroplastia de rodilla. Estudio experimental sobre un modelo sintético
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R. Pérez Mañanes
Autor para correspondencia
rubenperez.phd@gmail.com

Corresponding author.
, J. Vaquero Martín, M. Villanueva Martínez
Servicio Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Este artículo ha recibido
Información del artículo
Abstract
Objective

To assess the quality of the cement mantle obtained with different fixation techniques in knee arthroplasty.

Material and method

An experimental study with synthetic bone models (16 tibias and 16 femurs), employing a PROFIX® prosthetic tool and high viscosity cement (Palacos R®), applied on the second and fifth minute after mixing the components using two fixation techniques: directly over the bone surface by digital pressure (technique M), or over the prosthetic implant (technique P). We performed a digital analysis on the photographs of the models, determining for each cut plane: mean penetration, percentage penetration and length of the cement mantle.

Results

Technique M applied in minute 2 achieved a better quality mantle, with a mean penetration of 4.44mm and a percentage penetration of 79.36%; technique P in minute five obtained poorer results (2.12mm and 45.79%), these differences being significant (p=0.029). The femur tangential fixation (anterior and posterior) was unstable, with a mean penetration of 2mm. The mean length of the mantle in these two planes with technique M was 35 mm and 17.9mm, compared with technique P (12.5mm and 7.2mm), which achieved a coverage of < 50% (p=0.01).

Conclusions

Cementing over the bone surface with digital pressure achieves a greater depth and percentage penetration than direct cementing over the prosthetic implant, with greater differences when the cement viscosity is higher. Tangential fixation of the anterior and posterior cuts is very unstable if it is cemented over the implant.

Keywords:
Bone cement
Total knee arthroplasty
Synthetic model
Digital image analysis
Resumen
Objetivo

Evaluar la calidad del manto de cemento obtenido con diferentes técnicas de cementación en la artroplastia de rodilla.

Material y método

Estudio experimental con modelos óseos sintéticos (16 tibias y 16 fémures), empleando instrumental protésico PROFIX® y cemento de alta viscosidad (Palacos R®), aplicado en el segundo y quinto minuto tras la mezcla de componentes mediante dos técnicas de cementación: directamente sobre la superficie ósea por presurización digital (técnica M), o sobre el implante protésico (técnica P). Realizamos análisis digital de las fotografías de los modelos determinando para cada plano de corte: penetración media, porcentaje de penetración y longitud del manto de cemento.

Resultados

La técnica M empleada en el minuto dos consiguió una mejor calidad del manto, con una penetración media de 4,44mm y un porcentaje de penetración del 79,36%; la técnica P en el minuto cinco obtuvo los peores resultados (2,12mm y 45,79%), siendo estas diferencias significativas (p=0,029). La cementación de los planos tangenciales femorales (anterior y posterior) resultó precaria, con una penetración media de 2mm. La longitud media del manto de cemento en estos dos planos con la técnica M fue de 35mm y 17,9mm, en contraste con la técnica P (12,5mm y 7,2mm), que consiguió una cobertura < 50% (p=0,01).

Conclusiones

La cementación sobre la superficie ósea con presurización digital consigue mayor profundidad y porcentaje de penetración que con la cementación directa sobre los implantes protésicos, con mayores diferencias cuanto mayor es la viscosidad del cemento. La cementación tangencial de los cortes femorales anterior y posterior resulta muy precaria si se cementa sobre el implante.

Palabras clave:
Cemento óseo
Artroplastia total de rodilla
Modelo sintético
Análisis digital de imagen
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Paper presented under an anonymized submission system as a candidate for the 2010 SECOT Foundation award for basic research in Orthopaedic Surgery and Traumatology, drafted in accordance with the editorial instructions of the Revista Española de Cirugía Ortopédica y Traumatología.

Copyright © 2011. Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT). All rights reserved
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