Cementing technique for primary knee arthroplasty: a scoping review

Area of Science:

• Orthopedic Surgery
• Biomaterials Engineering

Background:

• The optimal cementing technique for primary total knee arthroplasty (TKA) is not well-established.
• Cementing is a critical step influencing the long-term success of TKA and unicondylar knee arthroplasty (UKA).

Purpose of the Study:

• To conduct a scoping review of existing literature on cementing techniques in primary TKA and UKA.
• To identify evidence-based recommendations for optimal cement application in knee arthroplasty.

Main Methods:

• A comprehensive literature search was performed across three databases, identifying 1,554 studies.
• Inclusion criteria focused on studies examining cement application methods, fixation strategies, and bone preparation techniques in primary TKA/UKA.
• 57 studies met the inclusion criteria for detailed analysis.

Main Results:

• Strong evidence supports pulsatile lavage irrigation, bone drying, and drilling holes in the tibia for TKA.
• Suction is recommended during TKA cementation.
• Using a cement gun is favored over finger packing, and full cementation is advised for metal-backed tibial components.
• Applying cement to both the implant and bone enhances cement penetration.

Conclusions:

• Despite knowledge gaps, specific techniques are recommended for primary TKA cementing.
• Pulsatile lavage irrigation, bone drying, drilling holes, and dual application of cement (bone and implant) are supported by current evidence.