1 BRJ Orthocentre and MAK Hospital, Eru Company Stop, Mettupalayam Road, Coimbatore, India

2 Amrita Institute of Medical Sciences, Ponekkara, Edappally, Kochi, Kerala, India

3 Kovai Medical Centre Hospital, Avanashi road, Peelamedu, Coimbatore, Tamil Nadu, India

4 Maxcure Hospitals, Hitech City, Madhapur, Hyderabad, Telangana, India

5 Sagar Hospital Banashankari, DSI Institutions kumarasamy layout, Bangalore, India


Background: No scientific evidence exists regarding the amount of bone cement used and discarded in primary
cemented Total knee arthroplasty (TKA). The aim of this study was to identify the exact amount of bone cement utilized
for component fixation in primary TKA.
Methods: In a prospective study carried out at five centers, 133 primary cemented TKAs were performed. One pack
of 40g Palacos bone cement (PBC 40) was hand mixed and digitally applied during the surgery. After fixation of the
TKA components, the remaining bone cement was methodically collected and weighed on a digital weighing scale. The
actual 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 solidified
dry weight of PBC 40. Among 133 knees, the cement usage was 20 % to 50% in 109 knees, more than 50% in 20 knees
and less than 20% in 4 knees. Knees which received larger sized femoral implant required more cement compared to
medium and small sizes. Knees which had pulse lavage had more cement utilization compared to knees which had
simple syringe lavage before implantation.
Conclusion: Large quantity of bone cement was handled than actual requirements in primary TKA when a
standard 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. Future
research is required to study the utility and economic impact of smaller packs (20 g or 30 g) of bone cement in
primary TKA.
Level of evidence: IV


Main Subjects

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