In total knee arthroplasty, infection has always been cited as being the number one cause of failure. However, more recent studies have shown aseptic loosening as the top reason for failure now. Proper cement technique is an important factor in reducing the occurrence of aseptic loosening. Clean and dried bone are important in achieving rigid cement fixation. Subchondral cysts may be hidden below the cut bone surface and may interfere with cement interdigitation. During a recent total knee arthroplasty case, a simple technique was developed for identifying and clearing out these cysts. By only using the suction tip, the gentle sweeping of the cut-surface will excavate hidden subchondral cysts allowing for improved cement interdigitation.
Conflict(s) of Interest
References with DOI
1. Bannister G, Miles A. The influence of cementing technique and blood on the strength of the bone-cement interface. New England Journal of Medicine. 1989:131-133.
2. Benjamin J, Gie G, Lee A, Ling R, Volz R. Cementing technique and the effects of bleeding. Journal of Bone and Joint Surgery. 1987: 620-624.
3. Cawley D, Kelly N, McGarry J, Shannon F. Cementing techniques for the tibial component in primary total knee replacement. The Bone and Joint Journal. 2013;95-B(3):295-300. https://doi.org/10.1302/0301-620x.95b3.29586
4. Crema MR, Zhu Y et al. Subchondral cystlike lesions deveop longitudinally in areas of bone marrow edema-like lesions in patients with or at risk for knee osteoarthritis. Radiology. 2010;256(3):855-862. https://doi.org/10.1148/radiol.10091467
5. Helwig P, Konstantinidis L, Hirschmuler A et al. Tibial cleaning method for cemented total knee arthroplasty: an experimental study. Indian Journal of Orthopaedics. 2013;47(1):18-22. https://doi.org/10.4103/0019-5413.106887
6. Hofmann A, Goldberg T, Tanner A, Cook T. Surface cementation of stemmed tibial components in primary total knee arthroplasty. The Journal of Arthroplasty. 2006;21(3):353-357. https://doi.org/10.1016/j.arth.2005.06.012
7. Lombardi A, Berend K, Adams J. Why knee replacements fail in 2013. The Bone and Joint Journal. 2014;96-B(11 Suppl A):101–4. https://doi.org/10.1302/0301-620x.96b11.34350
8. Marx R, Qunaibi M, Wirtz D, Niethard F, Mumme T. Surface pretreatment for prolonged survival of cemented tibial prostesis components: full- vs. surface-cementation technique. Biomedical Engineering Online, 2005:61-70.
9. Sharkey P, Lichstein P, Shen C, Tokarski A, Parvizi J. Why are total knee arthroplasties failing today - has anything changed after 10 years? The Journal of Arthroplasty. 2014:1774-1778. https://doi.org/10.1016/j.arth.2013.07.024
Boe, Richard Jr and Oliashirazi, Ali
"Technique to Improve Cement Penetration in Total Knee Arthroplasty,"
Marshall Journal of Medicine:
4, Article 11.
Available at: https://mds.marshall.edu/mjm/vol2/iss4/11