Cementing technique for primary knee arthroplasty: a scoping review

Authors

  • Anders M Refsum Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen
  • Uy V Nguyen Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen
  • Jan-Erik Gjertsen Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
  • Birgitte Espehaug Centre for Evidence-Based Practice, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen
  • Anne M Fenstad Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
  • Regina K Lein Medical Library, University of Bergen, Bergen, Norway
  • Peter Ellison Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
  • Paul J Høl Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
  • Ove Furnes 1 Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen

DOI:

https://doi.org/10.1080/17453674.2019.1657333

Abstract

Background and purpose — The optimal cementing technique for primary total knee arthroplasty (TKA) remains unclear. We therefore performed a scoping review based on available studies regarding cementation technique in primary TKA and unicondylar knee arthroplasty (UKA).

Patients and methods — A search in 3 databases identified 1,554 studies. The inclusion criteria were literature that studied cementing technique in primary TKA or UKA. This included cement application methods, full or surface cementing, applying cement to the bone and/or prosthesis, stabilization of the implant during curing phase, bone irrigation technique, drilling holes in the bone, use of suction,
and the timing of cementation. 57 studies met the inclusion criteria.

Results — The evidence was unanimously in favor of pulsatile lavage irrigation, drying the bone, and drilling holes into the tibia during a TKA. All studies concerning suction recommended it during TKA cementation. 7 out of 11 studies favored the use of a cement gun and no studies showed that finger packing was statistically significantly better than using a cement gun. There is evidence that full cementation should be used if metal-backed tibial components are used. Applying the cement to both implant and bone seems to give
better cement penetration.

Interpretation — There are still many knowledge gaps regarding cementing technique in primary TKA. There seems to be sufficient evidence to recommend pulsatile lavage irrigation of the bone, drilling multiple holes, and drying the bone before cementing and implant insertion, and applying cement to both implant and on the bone.

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Published

2019-08-27

How to Cite

Refsum, A. M. ., Nguyen, U. V., Gjertsen, J.-E., Espehaug, B., Fenstad, A. M., Lein, R. K., Ellison, P., Høl, P. J., & Furnes, O. (2019). Cementing technique for primary knee arthroplasty: a scoping review. Acta Orthopaedica, 90(6), 582–589. https://doi.org/10.1080/17453674.2019.1657333