The Open Orthopaedics Journal




ISSN: 1874-3250 ― Volume 13, 2019

Thermal Analysis of the Tibial Cement Interface with Modern Cementing Technique



Christopher J. Vertullo1, 2, *, David Zbrojkiewicz1, 3, Frank Vizesi4, William R. Walsh4
1 Knee Research Australia, Gold Coast, Australia
2 Centre for Musculoskeletal Research, Menzies Health Institute, Griffith University, Gold Coast, Australia
3 Department of Medicine, Griffith University, Gold Coast, Australia
3 Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, UNSW Australia, Randwick, New South Wales, Australia

Abstract

Background:

The major cause of cemented Total Knee Arthroplasty (TKA) failure is aseptic loosening of the tibial component necessitating revision surgery. Recently, multiple techniques have been described to maximize cement penetration depth and density in the proximal tibia during TKA to potentially avoid early loosening. While cement polymerisation is an exothermic reaction, minimal investigation into the proximal tibial thermal safety margin during cement polymerisation has been undertaken. In animal models osseous injury occurs at temperatures greater than 47 °C when applied for one minute. The aim of this study was to investigate the cement bone interface temperatures in TKA using modern tibial cementing techniques with a cadaveric tibial tray model.

Methods:

Eight adult cadavers were obtained with the proximal tibial surface prepared by a fellowship trained arthroplasty surgeon. Third generation cementation techniques were used and temperatures during cement polymerization on cadaveric knee arthroplasty models were recorded using thermocouples.

Results:

The results showed that no tibial cement temperature exceeded 44 °C for more than 1 minute. Two of the eight cadaveric tibias recorded maximum temperatures greater than 44 °C for 55 seconds and 33 seconds, just less than the 60 seconds reported to cause thermal injury. Average maximum polymerization temperatures did not correlate with deeper cement penetration or tray material. Maximum mantle temperatures were not statistically different between metal and all polyethylene tibial trays.

Conclusion:

Our investigation suggests that modern cementing techniques result in maximum mantle temperatures that are less than previously recorded temperatures required to cause thermal osseous injury, although this thermal injury safety margin is quite narrow at an average of 4.95 °C (95% confidence interval ± 4.31).

Keywords: Bone Cement, Cement Mantle, Cementing Techniques, Knee Arthroplasty, Polymethylmethacrylate, Thermonecrosis, Total Knee Replacement.


Article Information


Identifiers and Pagination:

Year: 2016
Volume: 10
First Page: 19
Last Page: 25
Publisher Id: TOORTHJ-10-19
DOI: 10.2174/1874325001610010019

Article History:

Received Date: 12/7/2015
Revision Received Date: 10/9/2015
Acceptance Date: 30/9/2015
Electronic publication date: 22/3/2016
Collection year: 2016

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© Vertullo et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the OSSM 8-10 Carrara Street, Benowa, QLD, 4217, Australia; Tel: +61 7 5564 8765; Fax: + 61 7 5597 0338; E-mail: chris.vertullo@icloud.com


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