Cementing Techniques In Knee Surgery (CeTIKS): a UK expert consensus study

Aseptic loosening remains a leading cause of failure after cemented total knee arthroplasty. Prior research has shown that cementation technique influences implant stability. However, no standardized guidelines exist for optimal cement application. That uncertainty drove the need for expert consensus on cementation methods. No prior work had resolved the best practices for cement pressurization or curing. Established knowledge includes the role of cement in load transfer and bone fixation. This gap motivated a study to synthesize expert opinion into actionable recommendations. The absence of high-quality evidence for cementation techniques highlights the need for consensus-based guidance. Expert opinion provides a valuable intermediary step until randomized trials confirm optimal methods.

The aim was to develop consensus on cementation techniques for total knee arthroplasty. Experts with significant clinical and academic experience were surveyed to identify best practices. The study focused on four key domains of cementation. The goal was to address variability in cement preparation and application. The motivation stemmed from the lack of standardized protocols in cemented TKA. The study aimed to reduce aseptic loosening by standardizing cementation. The Delphi method was chosen to aggregate expert judgment. The consensus process sought to bridge the gap between clinical practice and evidence.

The study used a modified Delphi consensus approach with three rounds of online surveys. Experts were selected based on clinical volume or academic output. The criteria included at least five years of NHS consultant experience. Participants were required to meet one of three inclusion criteria. The study focused on cement preparation, pressurization, application, and curing. A total of 81 experts participated in the first round. The final rounds included 80 experts who completed all statements. The process identified 24 statements across four domains for consensus evaluation.

Consensus was reached on 23 of 24 statements across four domains. Full agreement occurred in cement preparation, pressurization, and curing. Ninety percent agreement was achieved in the cement application domain. One statement about cement handling during initial application lacked consensus. The highest level of agreement was observed in pressurization techniques. Cement curing protocols received unanimous expert support. The study confirmed the importance of standardized cement preparation. The findings highlight the need for consistent cement application practices.

The CeTIKS study provides expert consensus on cementation techniques for TKA. The authors propose that these recommendations should guide clinical practice. The consensus reflects the current state of evidence in cemented arthroplasty. The authors suggest that pressurization and curing are critical domains. The lack of consensus on one statement indicates an area for further research. The authors state that expert opinion fills a gap in the evidence hierarchy. The authors recommend that surgeons consider these guidelines when cementing TKA components. These findings may inform future training programs in cemented arthroplasty.