Abstract
Introduction
New bone cement products have been developed attempting to shorten their setting time and thus cut down time in the operating room. This study determines whether faster-setting bone cement shortens time in the operating room, and whether the quantity used compromises postoperative TKA outcomes. Additionally, this study looks at cost analyses of the quantity of bone cement used in TKA procedures.
Materials and methods
One-hundred and sixty patients at a single institution with primary TKA surgeries between January 2019 and December 2021, and a clinic follow-up of at least one year, were identified. Five cement products used in this time period were identified and categorized by fast- or slow-setting products if their set times were marketed below or above six minutes, respectively.
Results
Estimated blood loss was higher in patients receiving fast-setting cements (160.0 vs 126.4 mL; p = 0.0009); however, operative time showed no difference between the cohorts (88.2 vs 89.2 min; p = 0.99). Fewer bags of cement were used for the fast cohort (1.3 vs 1.8 bags; p < 0.0001). The fast group was significantly cheaper on average per patient only when comparing between antibiotic bone cements (p = 0.007). No differences were found in postoperative outcomes between the two groups.
Conclusions
No differences were found in operative times between the fast and slow cemented groups. Fewer bags of faster-setting cement only proved cost saving relative to other antibiotic bone cements studied. Nonetheless, decreased usage of fast cement did not result in any different postoperative outcomes compared to slow cements.
Level of evidence
III.
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References
McGrory BJ, Weber KL, Jevsevar DS, Sevarino K (2016) Surgical management of osteoarthritis of the knee: evidence-based guideline. J Am Acad Orthop Surg. https://doi.org/10.5435/JAAOS-D-16-00159
MaraditKremers H, Larson DR, Crowson CS et al (2015) Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 97:1386–1397. https://doi.org/10.2106/JBJS.N.01141
Gwam CU, George NE, Etcheson JI et al (2019) Cementless versus cemented fixation in total knee arthroplasty: usage, costs, and complications during the inpatient period. J Knee Surg. https://doi.org/10.1055/s-0038-1675413
Wyatt RWB, Chang RN, Royse KE et al (2021) The association between cement viscosity and revision risk after primary total knee arthroplasty. J Arthroplast. https://doi.org/10.1016/j.arth.2021.01.052
Arsoy D, Pagnano MW, Lewallen DG et al (2013) Aseptic tibial debonding as a cause of early failure in a modern total knee arthroplasty design knee. Clin Orthop Relat Res. https://doi.org/10.1007/s11999-012-2467-4
Crawford DA, Berend KR, Nam D et al (2017) Low rates of aseptic tibial loosening in obese patients with use of high-viscosity cement and standard Tibial Tray: 2-year minimum follow-up. J Arthroplasty. https://doi.org/10.1016/j.arth.2017.04.018
Birkeland Ø, Espehaug B, Havelin LI, Furnes O (2017) Bone cement product and failure in total knee arthroplasty. Acta Orthop. https://doi.org/10.1080/17453674.2016.1256937
Kelly MP, Illgen RL, Chen AF, Nam D (2018) Trends in the use of high-viscosity cement in patients undergoing primary total knee arthroplasty in the United States. J Arthroplast. https://doi.org/10.1016/j.arth.2018.07.007
Kopec M, Milbrandt JC, Kohut N et al (2009) Effect of bone cement viscosity and set time on mantle area in total knee arthroplasty. Am J Orthop (Belle Mead NJ) 38:519–522
Kühn K-D (2013) PMMA Cements. Springer, Berlin Heidelberg
Medical H (2019) Palacos fast R+G: instructions for Use. Wehrheim, Germany
Medical H (2020) Palacos R: instructions for use. Wehrheim, Germany
Medical H (2020) Palacos R+G: instructions for use. Wehrheim, Germany
Medical H (2020) Palacos MV+G: instructions for use. Wehrheim, Germany
Simplex time charts and mixing guide. https://www.strykermeded.com/media/2950/sp_pg_1-ssp-ca1304-simplex-time-charts-mixing-guide.pdf. Accessed 20 Oct 2022
Satish BRJ, Thadi M, Thirumalaisamy S et al (2018) How much bone cement is utilized for component fixation in primary cemented total knee arthroplasty? Arch Bone Joint Surg 6:381–389
Matassi F, Carulli C, Civinini R, Innocenti M (2017) Cemented versus cementless fixation in total knee arthroplasty. Joints 1:121–5
Yan JR, Oreskovich S, Oduwole K et al (2018) Cement waste during primary total knee arthroplasty and its effect on cost savings: an institutional analysis. Cureus. https://doi.org/10.7759/cureus.3637
Maheshwari AV, Argawal M, Naziri Q et al (2015) Can cementing technique reduce the cost of a primary total knee arthroplasty? J Knee Surg. https://doi.org/10.1055/s-0034-137374
Zhou Y, Li L, Zhou Q et al (2015) Lack of efficacy of prophylactic application of antibiotic-loaded bone cement for prevention of infection in primary total knee arthroplasty: Results of a meta-analysis. Surg Infect (Larchmt). https://doi.org/10.1089/sur.2014.044
Hoskins T, Shah JK, Patel J et al (2020) The cost-effectiveness of antibiotic-loaded bone cement versus plain bone cement following total and partial knee and hip arthroplasty. J Orthop. https://doi.org/10.1016/j.jor.2020.01.029
Yayac M, Rondon AJ, Tan TL et al (2019) The economics of antibiotic cement in total knee arthroplasty: added cost with no reduction in infection rates. J Arthroplasty. https://doi.org/10.1016/j.arth.2019.04.043
van Hamersveld KT, Marang-van de Mheen PJ, Tsonaka R et al (2021) Risk factors for Tibial component loosening: a meta-analysis of long-term follow-up radiostereometric analysis data. J Bone Joint Surg Am. https://doi.org/10.2106/JBJS.20.01454
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Howie, C., McCrosson, M., Padgett, A.M. et al. The economic and clinical impact of fast- versus slow-setting cement in primary total knee arthroplasty. Arch Orthop Trauma Surg 144, 15–21 (2024). https://doi.org/10.1007/s00402-023-05017-3
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DOI: https://doi.org/10.1007/s00402-023-05017-3