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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


There has been a recent increase in interest for non-cemented fixation in total knee arthroplasty (TKA), however, the superiority of cement fixation is an ongoing debate. Whereas the results based on Level III and IV evidence show similar survivorship rates between the two types of fixation, Level I and II evidence strongly support cemented fixation. United Kingdom, Australia, Sweden, and New Zealand registry data show lower failure rates and greater usage of cemented than non-cemented fixation. Case series studies have also indicated greater functional outcomes and lower revision rates among cemented TKAs. Non-cemented fixation involves more patellofemoral complications, including increased susceptibility to wear due to a thinner polyethylene bearing on the cementless metal-backed component. The combination of results from registry data, prospective randomised studies, and meta-analyses support the current superiority of cemented fixation in TKAs.

Cement Technique: 1. Proper exposure with adequate length of incision; 2. Pulsatile lavage to the cut to clean the cancellous bone; 3. Drill holes in the sclerotic bone surfaces; 4. Heated Simplex cement at a doughy state; 5. Apply cement on the cut bony surfaces including the posterior femoral condyles and pressurised, apply cement on the components as well and; 6. Further pressurization in extension with trial insert.