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Revista Española de Cirugía Ortopédica y Traumatología (English Edition)
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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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References
[1.]
M.C. Dixon, R.R. Brown, D. Parsch, R.D. Scott.
Modular fixed-bearing total knee arthroplasty with retention of the posterior cruciate ligament. A study of patients followed for a minimum of fifteen years.
J Bone Joint Surg Am, 87 (2005), pp. 598-603
[2.]
E.M. Keating, J.B. Meding, P.M. Faris, M.A. Ritter.
Long-term followup of nonmodular total knee replacements.
Clin Orthop Relat Res, 404 (2002), pp. 34-39
[3.]
R.A. Berger, A.G. Rosenberg, R.M. Barden, M.B. Sheinkop, J.J. Jacobs, J.O. Galante.
Long-term followup of the Miller-Galante total knee replacement.
Clin Orthop Relat Res, 388 (2001), pp. 58-67
[4.]
D.E. Font-Rodríguez, G.R. Scuderi, J.N. Insall.
Survivorship of cemented total knee arthroplasty.
Clin Orthop Relat Res, 345 (1997), pp. 79-86
[5.]
E.M. Ferrer-Santacreu, A.C. Moreno-García, G. Arroyo-Salcedo, J.L. Leal-Helmling, M. Ruiz-Yague, S. Bello-Prats.
Supervivencia y resultado funcional a largo plazo de protésis de rodilla no cementadas.
Rev Ortop Traumatol, 54 (2010), pp. 106-110
[6.]
R. Gandhi, D. Tsvetkov, J.R. Davey, N.N. Mahomed.
Survival and clinical function of cemented and uncemented prostheses in total knee replacement: a meta-analysis.
J Bone Joint Surg Br, 91 (2009), pp. 889-895
[7.]
M.J. Lutz, B.R. Halliday.
Survey of current cementing techniques in total knee replacement.
ANZ J Surg, 72 (2002), pp. 437-439
[8.]
L. Cristofolini, M. Viceconti, A. Cappello, A. Toni.
Mechanical validation of whole bone composite femur models.
J Biomech, 29 (1996), pp. 525-535
[9.]
L. Cristofolini, M. Viceconti.
Mechanical validation of whole bone composite tibia models.
J Biomech, 33 (2000), pp. 279-288
[10.]
J.A. Grant, N.E. Bishop, N. Gotzen, C. Sprecher, M. Honl, M.M. Morlock.
Artificial composite bone as a model of human trabecular bone: the implant-bone interface.
J Biomech, 40 (2007), pp. 1158-1164
[11.]
A.D. Heiner.
Structural properties of fourth-generation composite femurs and tibias.
J Biomech, 41 (2008), pp. 3282-3284
[12.]
Annual book of ASTM standards. American Society for Testing and Materials; 2010.
[13.]
H. Morgan, V. Battista, S.S. Leopold.
Constraint in primary total knee arthroplasty.
J Am Acad Orthop Surg, 13 (2005), pp. 515-524
[14.]
K.A. Mann, D.C. Ayers, F.W. Werner, R.J. Nicoletta, M.D. Fortino.
Tensile strength of the cement-bone interface depends on the amount of bone interdigitated with PMMA cement.
J Biomech, 30 (1997), pp. 339-346
[15.]
P.S. Walker, M. Soudry, F.C. Ewald, H. McVickar.
Control of cement penetration in total knee arthroplasty.
Clin Orthop Relat Res, 185 (1984), pp. 155-164
[16.]
L.D. Dorr, J.P. Lindberg, M. Claude-Faugere, H.H. Malluche.
Factors influencing the intrusion of methylmethacrylate into human tibiae.
Clin Orthop Relat Res, 183 (1984), pp. 147-152
[17.]
C. Li, S. Kotha, C.H. Huang, J. Mason, D. Yakimicki, M. Hawkins.
Finite element thermal analysis of bone cement for joint replacements.
J Biomech Eng, 125 (2003), pp. 315-322
[18.]
C. Li, J. Mason, D. Yakimicki.
Thermal characterization of PMMA-based bone cement curing.
J Mater Sci Mater Med, 15 (2004), pp. 85-89
[19.]
M.J. Askew, J.W. Steege, J.L. Lewis, J.R. Ranieri, R.L. Wixson.
Effect of cement pressure and bone strength on polymethylmethacrylate fixation.
J Orthop Res, 1 (1984), pp. 412-420
[20.]
R.W. Klein, C.P. Scott, P.A. Higham.
The strength of acrylic bone cement cured under thumb pressure.
Biomaterials, 25 (2004), pp. 943-947
[21.]
M. Kopec, J.C. Milbrandt, T. Duellman, D. Mangan, D.G. Allan.
Effect of hand packing versus cement gun pressurization on cement mantle in total knee arthroplasty.
Can J Surg, 52 (2009), pp. 490-494
[22.]
M.A. Miller, A. Race, S. Gupta, P. Higham, M.T. Clarke, K.A. Mann.
The role of cement viscosity on cement-bone apposition and strength: an in vitro model with medullary bleeding.
J Arthroplasty, 22 (2007), pp. 109-116
[23.]
T.V. King, R.D. Scott.
Femoral component loosening in total knee arthroplasty.
Clin Orthop Relat Res, 194 (1985), pp. 285-290
[24.]
M. Vaninbroukx, L. Labey, B. Innocenti, J. Bellemans.
Cementing the femoral component in total knee arthroplasty: which technique is the best?.
[25.]
T. Scheerlinck, H. Delport, T. Kiewitt.
Influence of the cementing technique on the cement mantle in hip resurfacing: an in vitro computed tomography scan-based analysis.
J Bone Joint Surg Am, 92 (2010), pp. 375-387
[26.]
R.G. Bitsch, T. Loidolt, C. Heisel, T.P. Schmalzried.
Cementing techniques for hip resurfacing arthroplasty: development of a laboratory model.
J Bone Joint Surg Am, 90 (2008), pp. 102-110
[27.]
A.J. Bauze, J.J. Costi, P. Stavrou, W.A. Rankin, T.C. Hearn, J. Krishnan, et al.
Cement penetration and stiffness of the cement-bone composite in the proximal tibia in a porcine model.
J Orthop Surg (Hong Kong), 12 (2004), pp. 194-198
[28.]
A.D. Reading, A.W. McCaskie, M.R. Barnes, P.J. Gregg.
A comparison of 2 modern femoral cementing techniques: analysis by cement-bone interface pressure measurements, computerized image analysis, and static mechanical testing.
J Arthroplasty, 15 (2000), pp. 479-487

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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