Modern Cementing Technique

for improved clinical outcome1,2

Modern Cementing Technique (MCT) is a standardized and proven procedure for optimal implant fixation in order to improve clinical outcome and achieve long term implant survival.1,2  MCT addresses implant loosening and the objective of MCT is to provide long term implant stability in knee arthroplasty.  It is based on scientific data.1-26* findings by Zimmer Biomet27 and evidence-based techniques documented in the Swedish Hip Arthroplasty Register.1,2

The crucial factors in knee arthroplasty to achieve long term implant stability are to secure a strong bond and optimal interfaces, both between implant-cement and cement-bone.

Zimmer Biomet’s comprehensive assortment of bone cement and products for mixing and delivery, pressurization and bone bed preparation makes for one of the most complete portfolios for Modern Cementing Technique in the market today.

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Nozzle Knee Flat
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Knee Cementation Nozzle
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Refobacin® Bone Cement R and Biomet Bone Cement R
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ClearMix™ Vacuum Mixing System
ClearMix™ Delivery Gun
ClearMix™ Delivery Gun

Modern Cementing Technique Knee

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Implant-Cement Interface

  • Deliver the cement with a cement gun, and appropriate delivery devices, such as knee nozzles
  • Apply bone cement to implant first, as early as possible in the sticky phase 4,27
  • Prevent implant-cement interface contamination by implementing a “no-touch” policy4
Total Knee Replacement

Total Knee Replacement

Bone Cement

  • Use a bone cement with good mechanical and consistent handling properties
  • Mix and collect the cement under vacuum to reduce cement porosity and to improve mechanical strength8, 28*
Partial Knee Replacement

Partial Knee Replacement

Cement-Bone Interface

  • Perforate cancellous bone if dense or sclerotic24
  • Clean with high pressure pulsatile lavage repeatedly until clear fluid is received in the return line 29-31
  • Deliver the cement with a cement gun and appropriate delivery devices, such as knee nozzles
  • Deliver bone cement into tibial stem hole to achieve full cementation21-23

To learn more about Key Steps, download the Modern Cementing Technique brochure

 

*Bench test results not necessarily indicative of clinical performance.

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References

  1. Malchau H, et al. Prognosis of Total Hip Replacement. The National Hip Arthroplasty Register 1996: 9-11.
  2. Malchau H, et al. The Swedish Total Hip Replacement Register.The Journal of Bone and Joint Surgery. 84A: 2-20, 2002.
  3. Austin MS, et al. Knee Failure Mechanisms After Total Knee Arthroplasty. Techniques in Knee Surgery. 3(1):55–59, 2004.
  4. Kavanaugh A, et al. Factors Influencing the Initial Strength of the Tibial Tray-Cement Interface Bond. Bone Joint J. 95-B(34):98, 2013
  5. Shepard, M, et al. Influence of Cement Technique on the Interface Strength of Femoral Components. Orthopaedics and Related Research. 381:26-35, Dec 2000.
  6. Keller, J, et al. Factors affecting surgical alloy/ bone cement interface adhesion. Journal of Biomedical Materials Research. Vol. 14,639-651, 1980.
  7. Breusch SJ. Cementing techniques in Total Hip Replacement: factors influencing survival of femoral components. In: Bone Cements and Cementing Technique; Walenkamp GHIM, Murray DW (eds) Berlin, Heidelberg, Springer Verlag 2001.
  8. Wang J-S, et al. Porosity of bone cement reduced by mixing and collecting under vacuum. Acta Orthopedica Scandinavica. 64 (2): 143-146, 1993.
  9. Wang J-S, et al. Bone Cement Porosity in Vacuum Mixing Systems, Bone Cements and Cementing Technique 2001, Walenkamp, Murray (Eds). Springer Verlag.
  10. Dunne N-J, et al. Influence of the mixing techniques on the physical properties of acrylic bone cement. Biomaterials. 22: 1819-1826, 2001.
  11. Report from SP Technical Research Institute of Sweden (2007 08 13). Airborne Methyl Methacrylate Monomer During the use of Different Bone Cement Mixing Systems.
  12. Clarius M, et al. Pulsed lavage reduces the incidence of radiolucent lines under the tibial tray of Oxford unicompartmental knee arthroplasty. Pulsed lavage versus syringe lavage. International Orthopaedics (SICOT). 33:1585-1590, 2009.
  13. Christie J, et al. Medullary Lavage Reduces Embolic Phenomena and Cardopulmanory Changes During Cemented Hemiarthroplasty. The Journal of Bone and Joint Surgery. (Br). 77- B:456-9, 1995.
  14. Walker PS, et al. Control of Cement Penetration in Total Knee Arthroplasty. Clinical Orthopaedics and Related Research. 185:155-64, 1984.
  15. Miller MA, et al. Loss of Cement-bone Interlock in Retrieved Tibial Components from Total Knee Arthroplasties. Clinical Orthopaedics and Related Research. 472:304-313. 2014.
  16. Ritter MA, et al. Radiolucency at the Bone-Cement Interface in Total Knee Replacement. The Effect of Bone-Surface Reparation and Cement Technique. Journal of Bone and Joint Surgery (Am). 76(1):60-5,1994.
  17. Krause WR, et al. Strength of the Cement-Bone Interface. Orthopaedics and Related Research. 163:290-299,1982.
  18. Lutz MJ, et al. The Effect of Cement Gun and Cement Syringe Use on the Tibial Cement Mantle in Total Knee Arthroplasty. The Journal of Arthroplasty. 24(3): 461-67,2009.
  19. Yoga R, et al. Use of Cement Gun for Fixation of Tibia Component in Total Knee Arthroplasty. Malaysian Orthopaedic Journal. 3(1): 2009.
  20. Reading AD, et al. A Comparison of 2 Modern Femoral Cementing Techniques: Analysis by Cement-bone Interface Pressure Measurements, Computerized Image Analysis, and Static Mechanical Testing. The Journal of Arthroplasty. 15(4):479-87, 2000.
  21. Lombardi AV, et al. Surface Cementation of the Tibial Component in Total Knee Arthroplasty. Scientific Exhibit, 65th Annual Meeting of the American Academy of Orthopaedic Surgeons, New Orleans, Lousiana. February 19-23, 1998.
  22. Sisodial G, et al. Does Cementing Technique of the Tibial Component Influence Initial Fixation to Bone in Total Knee Arthroplasty? Full Versus Surface Cementation. The Bone & Joint Journal. 95-B(20):6, 2013
  23. Bert JM, et al. Is It Necessary to Cement the Tibial Stem in Cemented Total Knee Arthroplasty? Clinical Orthopaedics and Related Research. 356:73-78, 1998.
  24. Miskovsky C, et al. The Cemented Unicondylar Knee Arthroplasty. An In Vitro Comparison of Three Cement Techniques. Clinical Orthopaedics. 284: 1992.
  25. Cawley DT, et al. Cementing Techniques for the Tibial Component in Primary Total Knee Replacement. The Bone & Joint Journal. 95-B: 295-300, 2013.
  26. Diaz-Borjon E, et al. . Cement Penetration Using a Tibial Punch Cement Pressurizer in Total Knee Arthroplasty. Orthopedics. 27(5): 2004.
  27. Report Tensile-adhesion properties of Biomet Bone Cement R on 30 grit blasted CoCr, test number ATS LAB#17-25539, issued. Dec 2017. Data on file at Zimmer Biomet, Internal Laboratory Testing. Laboratory testing is not necessarily indicative of clinical performance.
  28. Lidgren, L, et al. Bone Cement Improved by Vacuum Mixing and Chilling. Acta Orthopaedica Scandinavica 57:27-32, 1987.
  29. Breusch SJ, et al. Pulmonary Embolism in Cemented Total Hip Arthroplasty. The Well-Cemented Total Hip Arthroplasty. Heidelberg, pp. 320-331, 2005.
  30. Anglen JO, et al. The efficacy of various irrigation solutions in removing slime-producing Staphylococcus Journal of Orthopaedic Trauma 8(5):390-6, 1994.
  31. Helmers, S, et al. Efficacy of Irrigation for Removal of Particulate Debris after Cemented Total Knee Arthroplasty. Journal of Arthroplasty. 14(5):549-52.1999.
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