Guidance for Cementing Total Knee Replacements

Cementing Total Knee Replacements 1.0 Introduction The survivorship of Total Knee Replacement (TKR) is dependent on, among other factors, the cementing technique used.1 Early attempts to use acrylic cement in orthopaedic surgery may have failed due to a misunderstanding around how the cement functions.2 Cement achieves a mechanical bond to the bone by penetrating into the pores of the cancellous bone where it hardens, forming a micro-interlock; modern cementing techniques aim to improve this micro-interlock. There are different cement considerations for TKR and Total Hip Replacement (THR). However,...

The behavior of cement is strongly temperature sensitive; increasing the cement's temperature will speed up the curing of the cement, however it will result in an earlier dough-time and significantly reduced available working time. NOTE: The user should refer to the specific instructions for use (package insert) for the timing and usage chart before preparing the cement. NOTE: Pre-warming powder or liquid beyond the temperature range stated in the instructions for use (package insert) is not recommended as it increases the risk of the cement being used too late in its working time phase. NOTE:...

Cementing Total Knee Replacements Examples of knee nozzles 65˚ Flanged Knee Nozzle Example of drilling keying holes in sclerotic tibial bone 4.1 Preparation of the Bone Surfaces Washing all the bone surfaces (e.g. with pulsatile lavage) to remove loose bone, blood, fat, and marrow also exposes the porous bone and helps to achieve penetration of bone cement13 resulting in a stronger interlock at the bonecement interface.14 The bone and implant should be dried prior to applying the cement; this may be achieved by drying in various ways including using an absorbent pad, such as a dry sponge, suction,...

Cementing Total Knee Replacements 4.3 Implantation NOTE: The surgeon should follow the implant system’s surgical technique guidelines for applying cement to the knee components. During implantation, cement must flow from around the periphery of the implant to generate an adequate seal between the implant and bone; this is important in preventing later ingress of osteolytic particles and debris. However, it is extremely important to remove excess cement from around the implant. By using the cement according to the instructions for use (working time for a given ambient temperature) and by watching...

Cementing Total Knee Replacements 4.3.2 Femoral Cementation A thick bed of cement may be placed onto the back of the implant or directly onto the exposed bone surface. An impactor is used to pressurize the cement. Good levels of penetration can be achieved by applying cement to the anterior and distal bone surfaces, and to the posterior flanges of the prosthesis prior to implantation.21 If applying cement to the bone it should be pressed sufficiently into the bone surface and peg holes prior to introducing the patella implant. Alternatively, a thick bed of cement can be applied to the implant....

6.0 Summary and Conclusion The following is a summary of recommended TKR cementing practices: • Drill keyholes especially in areas of dense or sclerotic bone. • Thoroughly wash all bone surfaces before cementing. • Keep all surfaces clean and dry, including gloves, bone, and implant surfaces. Do not apply saline to the cement surface. • Mix the cement under vacuum. • Use the cement within its working time. • Do not preheat the powder or liquid, especially with HV type cements, as this may impact the available working time. Follow the appropriate instructions for use on cement preparation. • If...

Cementing Total Knee Replacements 7.0 Ordering Information SMARTSET® MV Bone Cement SMARTSET® HV Bone Cement DePuy CMW 1 Gentamicin Bone Cement SMARTSET® MV Endurance Bone Cement SMARTSET® GMV Bone Cement Cat. No. DePuy CMW 2 Gentamicin Bone Cement Cat. No. SMARTSET® GHV Bone Cement Cat. No. 8    DePuy Synthes  Guidance for Cementing Primary TKR

Cementing Total Knee Replacements 8.0 References 1. Philips, A. M., Tomlinson, E., Goddard, N. J. (1996). Current technologies in total knee replacement: Results of a national survey. Annals of The Royal College of Surgeons of England, 78, 515-520. 13. Majokowski, R. S., Miles, A. W., Bannister, O. C., Perkins, J., Taylor, G. J. S. (1993). Bone surface preparation in cemented joint replacement. The Journal of Bone and Joint Surgery, 75 (3): 459-463. Charnley, J. (1972). Acrylic cement in orthopaedics surgery. Churchill Livingstone, 95. Guha, A. R., Debnath, U. K, Graham, N. M. (2008). Radiolucent...

Cementing Primary Total Knee Replacements 11    DePuy Synthes  Guidance for Cementing Primar

Cementing Primary Total Knee Replacements   Guidance for Cementing Primary TKR  DePuy Synthes 

Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed. Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information. CAUTION: Federal Law restricts these devices to sale by or on the order of a physician. Some devices listed in this surgical technique may not have been licensed in accordance...