Abstract
Introduction
The common causes of failure leading to revision Total Knee Replacement (TKR) include instability, infection, improper alignment, implant wear and osteolysis and improper cementation. This presentation outlines the details of the art of cementation.
Technique
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1.
Proper exposure with adequate length of incision
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2.
Avoid cutting of quadriceps tendon in oblique direction (medial-lateral plain)
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3.
Reduced Tissue Trauma Surgery (RTTS), no tourniquet except for cementing
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4.
Deliver the tibia in front of the femur (Ran-Sall maneuver)
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5.
Preserve supra-patellar pouch, coagulate lateral genicular artery
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6.
8 to 10 mm tibial cut from the uninvolved side, identify the cortical tibial cut
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7.
Adequate rotation, alignment, lateralisation and restoration of the posterior offset of the femoral component
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8.
Pulseatile lavage the cut surfaces to clean the cancellous bone
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9.
Drill holes in the sclerotic bone surface
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10.
Heated Simplex cement at a doughy state
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11.
Apply cement on the bone surfaces including posterior femoral condyles and pressurise, apply cement on the components as well
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12.
Apply manual constant pressure
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13.
Remove excess cement from posterior femoral condyles, tibia and patella (if resurfaced)
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14.
Further pressurisation in extension with trial insert
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15.
Release of the tourniquet and throughout irrigation
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16.
Closure in flexion without tourniquet and with good approximation of dermis and epidermis.
Discussion and Conclusion
Based on 15–20 year data, a properly cemented TKR has a survivorship between 93% to 98% with high level of function.
