How Much Bone Cement Is Utilized for Component Fixation in Primary Cemented Total Knee Arthroplasty?

Background: No scientific evidence exists regarding the amount of bone cement used and discarded in primarycemented Total knee arthroplasty (TKA). The aim of this study was to identify the exact amount of bone cement utilizedfor component fixation in primary TKA.Methods: In a prospective study carried out at five centers, 133 primary cemented TKAs were performed. One packof 40g Palacos bone cement (PBC 40) was hand mixed and digitally applied during the surgery. After fixation of theTKA components, the remaining bone cement was methodically collected and weighed on a digital weighing scale. Theactual quantity of cement utilized for component fixation was calculated.Results: On an average, 22.1 g of bone cement was utilized per joint, which accounted to 39 % of 57 g, the solidifieddry weight of PBC 40. Among 133 knees, the cement usage was 20 % to 50% in 109 knees, more than 50% in 20 kneesand less than 20% in 4 knees. Knees which received larger sized femoral implant required more cement compared tomedium and small sizes. Knees which had pulse lavage had more cement utilization compared to knees which hadsimple syringe lavage before implantation.Conclusion: Large quantity of bone cement was handled than actual requirements in primary TKA when astandard 40g pack was used with the digital application technique, resulting in sizeable discard of bone cement.Customizing cement pack according to the implant size can potentially avoid this cement wastage. Futureresearch is required to study the utility and economic impact of smaller packs (20 g or 30 g) of bone cement inprimary TKA.Level of evidence: IV