Tuesday, November 17, 2015

Total shoulder arthroplasty - glenoid cemening

Glenoid cement mantle characterization using micro–computed tomography of three cement application techniques

These authors compared 3 cementation methods to secure a central peg in 15 cadaveric glenoids:
(1) compression of multiple applications of cement using manual pressure over gauze with an Adson clamp,
(2) compression of multiple applications of cement using a pressurizer device, and 
(3) no compression of a single application of cement. 

Each glenoid was then imaged with high-resolution micro–computed tomography and further processed by creating 3-dimensional computerized models of implant, bone, and cement geometry.

There were no significant differences detected between the 2 types of compression techniques; however, there was a significant difference between compression methods and use of no compression at all. All morphologic characteristics of a larger cement mantle were significantly correlated with greater cortical contact.

Comment: The primary concerns in stabilizing a glenoid component to glenoid bone are (1) preserving glenoid bone stock, (2) reaming the face of the glenoid only to the point where there is a good fit between the back of the component and the bony face of the glenoid, (3) assuring that the peg holes in bone are precisely aligned to match the geometry of the glenoid component, (4) avoiding cement between the bony face of the glenoid and back of the component, (5) using a 'magic peg' for primary fixation, and (6) pressurizing the peripheral fixation holes. Our technique for glenoid arthroplasty is shown in this link.

 Excessive cement can give rise to excessive heat (see this link).

This paper demonstrates that pressurization can increase the intravasation of cement into bone, but if the carpentry is done well, a minimal amount of cement "putty" is necessary


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