title: Thermal Analysis of the Tibial Cement Interface with Modern Cementing Technique.
abstract: BACKGROUND
  The major cause of cemented Total Knee Arthroplasty (TKA) failure is aseptic loosening of the tibial component necessitating revision surgery. Recently, multiple techniques have been described to maximize cement penetration depth and density in the proximal tibia during TKA to potentially avoid early loosening. While cement polymerisation is an exothermic reaction, minimal investigation into the proximal tibial thermal safety margin during cement polymerisation has been undertaken. In animal models osseous injury occurs at temperatures greater than 47 °C when applied for one minute. The aim of this study was to investigate the cement bone interface temperatures in TKA using modern tibial cementing techniques with a cadaveric tibial tray model.
  
  
  METHODS
  Eight adult cadavers were obtained with the proximal tibial surface prepared by a fellowship trained arthroplasty surgeon. Third generation cementation techniques were used and temperatures during cement polymerization on cadaveric knee arthroplasty models were recorded using thermocouples.
  
  
  RESULTS
  The results showed that no tibial cement temperature exceeded 44 °C for more than 1 minute. Two of the eight cadaveric tibias recorded maximum temperatures greater than 44 °C for 55 seconds and 33 seconds, just less than the 60 seconds reported to cause thermal injury. Average maximum polymerization temperatures did not correlate with deeper cement penetration or tray material. Maximum mantle temperatures were not statistically different between metal and all polyethylene tibial trays.
  
  
  CONCLUSIONS
  Our investigation suggests that modern cementing techniques result in maximum mantle temperatures that are less than previously recorded temperatures required to cause thermal osseous injury, although this thermal injury safety margin is quite narrow at an average of 4.95 °C (95% confidence interval ± 4.31).
authors.affiliation: Knee Research Australia, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute, Griffith University, Gold Coast, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Vertullo
authors.affiliation: Knee Research Australia, Gold Coast, Australia; Centre for Musculoskeletal Research, Menzies Health Institute, Griffith University, Gold Coast, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Zbrojkiewicz
authors.affiliation: Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, UNSW Australia, Randwick, New South Wales, Australia.
authors.forename: Frank
authors.initials: F
authors.lastname: Vizesi
authors.affiliation: Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, UNSW Australia, Randwick, New South Wales, Australia.
authors.forename: William R
authors.initials: WR
authors.lastname: Walsh
keywords: Bone Cement; Cement Mantle; Cementing Techniques; Knee Arthroplasty; Polymethylmethacrylate; Thermonecrosis; Total Knee Replacement.