HOW TO IMPROVE CEMENT PRESSURISATION IN THE DISTAL HUMERUS DURING ELBOW REPLACEMENT? A CADAVERIC STUDY ON A NOVEL TECHNIQUE

Abstract

Cement pressurisation in the distal humerus is technically difficult due to the anatomy of the humeral intramedullary (IM) cavity. Conventional cement restrictors often migrate proximally, reducing the effect of pressurisation during arthroplasty. Theoretically with a better cement bone interdigitation, the longevity of the elbow replacement can be improved.

The aim of this cadaveric study was to evaluate the usefulness of a novel technique for cementation.

Eight paired cadaveric elbows were used. The sides were randomly allocated to the conventional cementation group and pressurisation using a foley cathetre used as a cement restrictor. The cathetre was inserted into the IM canal after thorough washout and drying the cavity. The balloon inflated to act as a cement restrictor. Cementation was then performed and the cathetre removed just prior to cement setting. Radiographs of each pair was taken. Each distal humerus sample was cut in 1 cm increments starting from proximal part of the coronoid fossa. The slices were also radiographed to assess cement-bone interdigitation. The area of IM canal and the cement were calculated. The paired samples were compared.

The new technique consistently and significantly achieved a better cement interdigitation into the cancellous bone. The maximum penetration was observed in the proximal 1–3 cms from the coronoid fossa. According to previous studies, this area is the most common part involved in cement failure and loosening.

This study confirms the effectiveness of a foley cathetre as a cement restrictor. The ease of the technique and excellent pressurisation achived support its use.