Does a simple syringe applicator enhance bone cement set up time in knee arthroplasty?

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Surgical Techniques

Background:

• Polymethylmethacrylate (PMMA) cement setting time is influenced by variables like mixing technique, temperature, and pressure.
• Efficient cement application is crucial for optimizing surgical workflow in arthroplasty.

Purpose of the Study:

• To compare the setting time of PMMA cement applied via a syringe versus a traditional mixing bowl.
• To calculate the potential national and individual surgeon cost savings associated with reduced PMMA setting times.

Main Methods:

• Evaluated PMMA setting times in 146 knee arthroplasty patients (unicompartmental and patellofemoral).
• Compared setting times of PMMA from a mixing bowl versus PMMA dispensed from a syringe.
• Calculated annual cost differences based on operative time savings.

Main Results:

• Syringe application resulted in a significantly shorter mean setting time (15.1 ± 1.7 minutes) compared to the bowl method (16.8 ± 2.1 minutes).
• An estimated 1.7 minutes saved per case could yield 595,000 annual operating room minutes saved in the US.
• Projected annual cost savings of nearly $71 million nationally and $110,000 per surgeon.

Conclusions:

• A simple syringe applicator significantly enhances PMMA cement setting time, potentially due to pressure differences.
• Syringe application offers improved control and precision, providing a valuable time advantage for arthroplasty surgeons.
• This method presents a cost-effective strategy for improving surgical efficiency in joint replacement procedures.