title: Intrusion Characteristics of High Viscosity Bone Cements for the Tibial Component of a Total Knee Arthroplasty Using Negative Pressure Intrusion Cementing Technique.
abstract: With the advent of new bone cements with different viscosities, it is important to understand how they respond to different cementing techniques. The purpose of this study was to evaluate the high viscosity (HV) bone cement intrusion characteristics comparing negative pressure intrusion technique (NPI) and finger-packing technique in a cadaveric proximal tibial bone.
  
  
  
  Soft tissues were removed from twenty- four fresh frozen cadaver proximal tibiae, and standard arthroplasty tibial cuts were performed. Palacos-R (Zimmer, Warsaw, IN) and Simplex-HV (Stryker Howmedica Osteonics, Mahwah, NJ) bone cement were used. Each tibia was randomly assigned to receive one of the two bone cements with finger-packing technique and NPI technique. Forty-five Newton weight was applied along the long axis of the tibia during cement-setting phase. Once the cement had cured, sagittal sections were prepared and analyzed for cement penetration depth using digital photography and stereoscopic micrographs. Area of interest (AOI) for each specimen was also used to quantitatively evaluate the area of cement penetration.
  
  
  
  When using Palacos-R, significant dif ferences were detected in cement penetration between the two cementing techniques. On the other hand, when using Simplex-HV, cement penetration was not significantly increased with finger-packing technique when compared to NPI technique. When comparing the two high-viscosity bone cements when using NPI cementing technique, significant differences were detected at Zone 4, where Simplex-HV penetrated deeper than the Palacos-R. When finger-packing technique was used with Simplex-HV, significant differences were detected in bone cement penetration at Zones 3-5. When looking at AOI, no significant differences were found between the Palacos-R and Simplex-HV bone cements in terms of penetration depths with NPI technique. Higher penetration depths were achieved with Simplex-HV bone cement compared to Palacos-R cement in finger packing technique.
  
  
  
  The data demonstrated that the combination of different bone cement formulations and the cementing technique has a significant effect on cement penetration into the cut bone surface.
authors.affiliation: Department of Orthopaedic Surgery, The University of Kansas School of Medicine- Wichita, 929 N. Saint Francis, Wichita, KS 67214.
authors.forename: Nam L
authors.initials: NL
authors.lastname: Dinh
authors.affiliation: Department of Orthopaedic Surgery, The University of Kansas School of Medicine- Wichita, 929 N. Saint Francis, Wichita, KS 67214; Department of Graduate Medical Education, Via Christi Health, 929 N. Saint Francis, Wichita, KS 67214.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Chong
authors.affiliation: Department of Orthopaedic Surgery, The University of Kansas School of Medicine- Wichita, 929 N. Saint Francis, Wichita, KS 67214.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Walden
authors.affiliation: Department of Orthopaedic Surgery, The University of Kansas School of Medicine- Wichita, 929 N. Saint Francis, Wichita, KS 67214.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Adrian
authors.affiliation: Department of Orthopaedic Surgery, The University of Kansas School of Medicine- Wichita, 929 N. Saint Francis, Wichita, KS 67214.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Cusick
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001843:Bone Cements; D002484:Cementation / Q000379:methods*; D006801:Humans; D013977:Tibia / Q000601:surgery*; D014783:Viscosity
chemical_list: D001843:Bone Cements