How Much Bone Cement Is Utilized for Component Fixation in Primary Cemented Total Knee Arthroplasty?

Abstract

Background: No scientific evidence exists regarding the amount of bone cement used and discarded in primary<br />cemented Total knee arthroplasty (TKA). The aim of this study was to identify the exact amount of bone cement utilized<br />for component fixation in primary TKA.<br />Methods: In a prospective study carried out at five centers, 133 primary cemented TKAs were performed. One pack<br />of 40g Palacos bone cement (PBC 40) was hand mixed and digitally applied during the surgery. After fixation of the<br />TKA components, the remaining bone cement was methodically collected and weighed on a digital weighing scale. The<br />actual quantity of cement utilized for component fixation was calculated.<br />Results: On an average, 22.1 g of bone cement was utilized per joint, which accounted to 39 % of 57 g, the solidified<br />dry weight of PBC 40. Among 133 knees, the cement usage was 20 % to 50% in 109 knees, more than 50% in 20 knees<br />and less than 20% in 4 knees. Knees which received larger sized femoral implant required more cement compared to<br />medium and small sizes. Knees which had pulse lavage had more cement utilization compared to knees which had<br />simple syringe lavage before implantation.<br />Conclusion: Large quantity of bone cement was handled than actual requirements in primary TKA when a<br />standard 40g pack was used with the digital application technique, resulting in sizeable discard of bone cement.<br />Customizing cement pack according to the implant size can potentially avoid this cement wastage. Future<br />research is required to study the utility and economic impact of smaller packs (20 g or 30 g) of bone cement in<br />primary TKA.<br />Level of evidence: IV